Healthcare Provider Details

I. General information

NPI: 1760995971
Provider Name (Legal Business Name): KAYLA JO HILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 ROSS CARTER BLVD
DUFFIELD VA
24244-5116
US

IV. Provider business mailing address

459 WILL AND EMMA LN
CLINTWOOD VA
24228-7684
US

V. Phone/Fax

Practice location:
  • Phone: 276-431-2841
  • Fax: 276-431-4718
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number0131000763
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: