Provider Demographics
NPI:1689482077
Name:HILL, EBONY NICOLE (LMT)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:NICOLE
Last Name:HILL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16739 STANFORD PLACE DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-3214
Mailing Address - Country:US
Mailing Address - Phone:314-372-6492
Mailing Address - Fax:
Practice Address - Street 1:16739 STANFORD PLACE DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034-3214
Practice Address - Country:US
Practice Address - Phone:314-372-6492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023034519225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist