Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 2011031619 | MO |
NPI | 1003177684 |
---|---|
Provider Name | Miss Kaitlin Marie Chilman |
First Address | Fenton, MO 63026-5668 |
Second Address | Saint Louis, MO 63110-4048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2012 |
Last Update Date | 31/05/2012 |