Provider Demographics
NPI:1063686723
Name:KILBURN, RHEALINE EDWINNA (COTA)
Entity Type:Individual
Prefix:MRS
First Name:RHEALINE
Middle Name:EDWINNA
Last Name:KILBURN
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 1:7109 CALUMET RD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2701
Mailing Address - Country:US
Mailing Address - Phone:806-353-1064
Mailing Address - Fax:
Practice Address - Street 1:1301 MESA DR
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-3905
Practice Address - Country:US
Practice Address - Phone:180-629-6576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209925225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist