Healthcare Provider Details

I. General information

NPI: 1326513896
Provider Name (Legal Business Name): MR. BAILEY J HILL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2018
Last Update Date: 10/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11240 WAPLES MILL RD STE 101
FAIRFAX VA
22030-6078
US

IV. Provider business mailing address

2727 S QUINCY ST APT 1011
ARLINGTON VA
22206-2360
US

V. Phone/Fax

Practice location:
  • Phone: 703-237-2219
  • Fax: 703-237-2729
Mailing address:
  • Phone: 630-715-4359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-39640
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: