MEDICARE: KAITLYN KILGORE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT0000005601	TN

General Provider Information

NPI Number	:	1548791346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN KILGORE

Provider Business Mailing Address
First Line	:	193 HOLSTON COURT LN
Second Line	:
City	:	WEBER CITY
State	:	VA
Zip	:	24290-8065
Country	:	US
Telephone Number	:	423-502-1318
Fax Number	:

Provider Business Practice Location Address
First Line	:	193 HOLSTON COURT LN
Second Line	:
City	:	WEBER CITY
State	:	VA
Zip	:	24290-8065
Country	:	US
Telephone Number	:	423-502-1318
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2017
Last Update Date	:	03/23/2017

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Directions to “ KAITLYN KILGORE ” Practice Location

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