MEDICARE: KATHLEEN KILLIAN

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	225100000X	Physical Therapist	1260126	TX
2	208100000X	Physical Medicine & Rehabilitation Physician	PT015430	OH

General Provider Information

NPI Number	:	1598148454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN KILLIAN

Provider Business Mailing Address
First Line	:	24400 HIGHPOINT RD STE 10
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-6027
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15900 SNOW RD STE 500
Second Line	:
City	:	BROOKPARK
State	:	OH
Zip	:	44142-2860
Country	:	US
Telephone Number	:	216-265-3454
Fax Number	:

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

Provider Enumeration Date	:	07/09/2015
Last Update Date	:	02/28/2019

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Directions to “ KATHLEEN KILLIAN ” Practice Location

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