Healthcare Provider Details

I. General information

NPI: 1871415786
Provider Name (Legal Business Name): KILEY ANNE SOUZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 GREEN END AVE
MIDDLETOWN RI
02842-5620
US

IV. Provider business mailing address

183 FISH RD
TIVERTON RI
02878-3616
US

V. Phone/Fax

Practice location:
  • Phone: 401-849-7100
  • Fax:
Mailing address:
  • Phone: 774-319-2911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT02462
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: