Healthcare Provider Details

I. General information

NPI: 1275135360
Provider Name (Legal Business Name): MRS. KAITLIN ELIZABETH LILLARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2009 MACKENZIE WAY STE 100
CRANBERRY TOWNSHIP PA
16066-5338
US

IV. Provider business mailing address

443 SANFORD ST
MORGANTOWN WV
26501-6548
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 304-282-2772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number1-21-51933
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-51933
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: