1760422588 NPI number — PROF. JACQUELIN KAY KILBURN OT

Table of content: PROF. JACQUELIN KAY KILBURN OT (NPI 1760422588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760422588 NPI number — PROF. JACQUELIN KAY KILBURN OT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KILBURN
Provider First Name:
JACQUELIN
Provider Middle Name:
KAY
Provider Name Prefix Text:
PROF.
Provider Name Suffix Text:
Provider Credential Text:
OT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCONKEY
Provider Other First Name:
JACQUELIN
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760422588
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 205
Provider Second Line Business Mailing Address:
10400 HAMBURG RD
Provider Business Mailing Address City Name:
HAMBURG
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48139-0205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-231-9042
Provider Business Mailing Address Fax Number:
810-231-9063

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10400 HAMBURG RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMBURG
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48139-1204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-231-9042
Provider Business Practice Location Address Fax Number:
810-231-9063
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XN1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: NOT REQUIRED , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com