Healthcare Provider Details

I. General information

NPI: 1225654940
Provider Name (Legal Business Name): ERIN KILLEN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8960 BROWNS BRIDGE RD
GAINESVILLE GA
30506-4010
US

IV. Provider business mailing address

8960 BROWNS BRIDGE RD
GAINESVILLE GA
30506-4010
US

V. Phone/Fax

Practice location:
  • Phone: 334-207-0582
  • Fax: 855-232-8604
Mailing address:
  • Phone: 334-207-0582
  • Fax: 855-232-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4433
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7683
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: