Provider Demographics
NPI:1013140433
Name:PRICE, KILEY MICHELLE (COTA)
Entity type:Individual
Prefix:MS
First Name:KILEY
Middle Name:MICHELLE
Last Name:PRICE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 686
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-0686
Mailing Address - Country:US
Mailing Address - Phone:304-574-3888
Mailing Address - Fax:304-574-3888
Practice Address - Street 1:106 TYREE ST.
Practice Address - Street 2:
Practice Address - City:ANSTED
Practice Address - State:WV
Practice Address - Zip Code:25812
Practice Address - Country:US
Practice Address - Phone:304-658-5271
Practice Address - Fax:304-658-4153
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVC1356224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant