Provider Demographics
NPI:1003177684
Name:CHILMAN, KAITLIN MARIE (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:KAITLIN
Middle Name:MARIE
Last Name:CHILMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 CORISANDE HILLS RD
Mailing Address - Street 2:APT 1
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-5668
Mailing Address - Country:US
Mailing Address - Phone:618-841-7444
Mailing Address - Fax:
Practice Address - Street 1:3625 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-4048
Practice Address - Country:US
Practice Address - Phone:618-841-7444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011031619225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist