Healthcare Provider Details

I. General information

NPI: 1730154311
Provider Name (Legal Business Name): KIMBERLY HILLMAN OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 BRYCE LN
FLOWER MOUND TX
75077-7038
US

IV. Provider business mailing address

6000 N ALLEN RD
PEORIA IL
61614-3294
US

V. Phone/Fax

Practice location:
  • Phone: 940-241-1215
  • Fax: 940-455-2041
Mailing address:
  • Phone: 309-691-1400
  • Fax: 309-693-3197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056005139
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: