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NPI Code Detail

MEDICARE: JILLIAN HICKS

MEDICARE: JILLIAN HICKS
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
1224Z00000XOccupational Therapy Assistant6589NC

General Provider Information

NPI Number : 1972770477
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILLIAN HICKS
Provider Business Mailing Address
First Line : 410 N FIFTH ST
Second Line :
City : MEBANE
State : NC
Zip : 27302-2508
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 411 S LASALLE ST
Second Line :
City : DURHAM
State : NC
Zip : 27705-3701
Country : US
Telephone Number : 191-938-3552
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2008
Last Update Date : 05/14/2008

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Directions to “ JILLIAN HICKS ” Practice Location

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