Healthcare Provider Details

I. General information

NPI: 1760422588
Provider Name (Legal Business Name): JACQUELIN KAY KILBURN OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACQUELIN KAY MCCONKEY OT

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 HAMBURG RD
HAMBURG MI
48139-1204
US

IV. Provider business mailing address

PO BOX 205 10400 HAMBURG RD
HAMBURG MI
48139-0205
US

V. Phone/Fax

Practice location:
  • Phone: 810-231-9042
  • Fax: 810-231-9063
Mailing address:
  • Phone: 810-231-9042
  • Fax: 810-231-9063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberNOT REQUIRED
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: