Healthcare Provider Details

I. General information

NPI: 1548179765
Provider Name (Legal Business Name): KAITLIN MILLILO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 HILLSIDE LN
MOUNT LAUREL NJ
08054-4517
US

IV. Provider business mailing address

76 HILLSIDE LN
MOUNT LAUREL NJ
08054-4517
US

V. Phone/Fax

Practice location:
  • Phone: 609-922-6557
  • Fax:
Mailing address:
  • Phone: 609-922-6557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOC021045
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: