=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245747484
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA DAWN HILLER RBT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2018
-----------------------------------------------------
Last Update Date | 01/09/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11510 242ND AVENUE CT E
-----------------------------------------------------
City | BUCKLEY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98321-9085
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-257-0613
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11510 242ND AVENUE CT E
-----------------------------------------------------
City | BUCKLEY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98321-9085
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-257-0916
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------