Basic Information
| Provider Information | |||||||||
| NPI: | 1255601720 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KILEY | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6960 DESTINY DR | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | ROCKLIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956772993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164150119 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6960 DESTINY DR | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | ROCKLIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956772993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164150119 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2011 | ||||||||
| LastUpdateDate: | 03/16/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0200X | OT 11987 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.