Provider Demographics
NPI:1275884058
Name:KILGORE, CHRISTINA (OT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:KILGORE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:620 N DIERS AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4984
Mailing Address - Country:US
Mailing Address - Phone:308-382-0344
Mailing Address - Fax:308-382-3241
Practice Address - Street 1:3004 W FAIDLEY AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4109
Practice Address - Country:US
Practice Address - Phone:308-398-5170
Practice Address - Fax:308-398-5175
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE770225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist