Provider Demographics
NPI:1235571035
Name:KILPATRICK SMALL, ALISA E (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:E
Last Name:KILPATRICK SMALL
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 S JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-2050
Mailing Address - Country:US
Mailing Address - Phone:219-395-4004
Mailing Address - Fax:
Practice Address - Street 1:428 S JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-2050
Practice Address - Country:US
Practice Address - Phone:219-395-4004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004959A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist