Provider Demographics
NPI:1043883705
Name:KILIAN-WEIDES, KRISTEN (OT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:KILIAN-WEIDES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:THERMOPOLIS
Mailing Address - State:WY
Mailing Address - Zip Code:82443-0790
Mailing Address - Country:US
Mailing Address - Phone:307-864-2146
Mailing Address - Fax:307-864-2857
Practice Address - Street 1:1526 RUMSEY AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3871
Practice Address - Country:US
Practice Address - Phone:307-578-1970
Practice Address - Fax:307-578-1973
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1515225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist