Provider Demographics
NPI:1235905464
Name:AYSCUE, KILLIAN
Entity Type:Individual
Prefix:
First Name:KILLIAN
Middle Name:
Last Name:AYSCUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 PITCHING WEDGE DR APT 104
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-2858
Mailing Address - Country:US
Mailing Address - Phone:704-678-5970
Mailing Address - Fax:
Practice Address - Street 1:186 WIND CHIME CT STE 104
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6486
Practice Address - Country:US
Practice Address - Phone:919-870-1280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16389225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist