Provider Demographics
NPI:1164686945
Name:KILLINGSWORTH, AUDRA MICHELLE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:AUDRA
Middle Name:MICHELLE
Last Name:KILLINGSWORTH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:AUDRA
Other - Middle Name:MICHELLE
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1995 NW CARY PARKWAY
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560
Mailing Address - Country:US
Mailing Address - Phone:919-455-7851
Mailing Address - Fax:
Practice Address - Street 1:1995 NW CARY PARKWAY
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560
Practice Address - Country:US
Practice Address - Phone:919-469-1120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6096225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist