MEDICARE: MRS. SHANA I HILL OT

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	225X00000X	Occupational Therapist	OTR650	AR

General Provider Information

NPI Number	:	1861547606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANA I HILL OT

Provider Business Mailing Address
First Line	:	1909 N SECOND ST
Second Line	:
City	:	CABOT
State	:	AR
Zip	:	72023
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1909 N 2ND ST
Second Line	:
City	:	CABOT
State	:	AR
Zip	:	72023-2209
Country	:	US
Telephone Number	:	501-843-7157
Fax Number	:

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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