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NPI Code Detail

MEDICARE: MS. ANITRA ROCHELLE KILLEBREW OTR

MEDICARE: MS. ANITRA ROCHELLE KILLEBREW OTR
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
1225X00000XOccupational TherapistR4397KY
2225X00000XOccupational Therapist300560LA

General Provider Information

NPI Number : 1598121451
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANITRA ROCHELLE KILLEBREW OTR
Provider Business Mailing Address
First Line : 4622 S 6TH ST
Second Line : APT#3
City : LOUISVILLE
State : KY
Zip : 40214-2463
Country : US
Telephone Number : 502-523-4608
Fax Number :
Provider Business Practice Location Address
First Line : 1755 WITTINGTON PL STE 175
Second Line : SUITE #175
City : DALLAS
State : TX
Zip : 75234-1905
Country : US
Telephone Number : 800-733-1676
Fax Number : 804-346-5050
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2016
Last Update Date : 01/07/2016

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