MEDICARE: DEIDRA MICHELLE HILL B.A, M.A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1275840365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEIDRA MICHELLE HILL B.A, M.A

Provider Business Mailing Address
First Line	:	1649 E 50TH ST
Second Line	:	APARTMENT #22B
City	:	CHICAGO
State	:	IL
Zip	:	60615-3128
Country	:	US
Telephone Number	:	708-825-7584
Fax Number	:	773-487-9062

Provider Business Practice Location Address
First Line	:	1649 E 50TH ST
Second Line	:	APARTMENT #22B
City	:	CHICAGO
State	:	IL
Zip	:	60615-3128
Country	:	US
Telephone Number	:	708-825-7584
Fax Number	:	773-487-9062

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2010
Last Update Date	:	09/10/2010

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