Provider Demographics
NPI:1831577154
Name:KILGORE, GENEVIEVE ANN (COTA)
Entity type:Individual
Prefix:MRS
First Name:GENEVIEVE
Middle Name:ANN
Last Name:KILGORE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9119 BRIAN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-4487
Mailing Address - Country:US
Mailing Address - Phone:440-537-0193
Mailing Address - Fax:
Practice Address - Street 1:27569 DETROIT RD # R
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2200
Practice Address - Country:US
Practice Address - Phone:440-641-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.05860224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant