Provider Demographics
NPI:1952819765
Name:KILLOUGH, CECILE DIANE (OT)
Entity Type:Individual
Prefix:
First Name:CECILE
Middle Name:DIANE
Last Name:KILLOUGH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:CECILE
Other - Middle Name:DIANE
Other - Last Name:KILLOUGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:135 PIN OAK LN
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-8741
Mailing Address - Country:US
Mailing Address - Phone:270-339-6571
Mailing Address - Fax:
Practice Address - Street 1:515 GREENE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42345-1409
Practice Address - Country:US
Practice Address - Phone:270-338-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-15
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY131798225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist