Provider Demographics
NPI:1639432669
Name:KILGO, LUANNE THOMAS (OTR/L)
Entity Type:Individual
Prefix:
First Name:LUANNE
Middle Name:THOMAS
Last Name:KILGO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 KRISTY LN
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-3054
Mailing Address - Country:US
Mailing Address - Phone:706-965-4819
Mailing Address - Fax:
Practice Address - Street 1:960 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:30747-1930
Practice Address - Country:US
Practice Address - Phone:706-857-4761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT002495225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist