Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 056011367 | IL |
NPI | 1023593209 |
---|---|
Provider Name | Matthew Kent Kilian |
First Address | Downers Grove, IL 60515-1394 |
Second Address | Downers Grove, IL 60515-1394 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2018 |
Last Update Date | 03/10/2018 |