Provider Demographics
NPI:1447024021
Name:HILL, ANTWAN TERRAL I
Entity type:Individual
Prefix:
First Name:ANTWAN
Middle Name:TERRAL
Last Name:HILL
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6409 STARDUST DR S
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-3639
Mailing Address - Country:US
Mailing Address - Phone:817-319-2730
Mailing Address - Fax:
Practice Address - Street 1:8500 EMERALD HILLS WAY
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-5662
Practice Address - Country:US
Practice Address - Phone:817-577-3337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215283224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant