Provider Demographics
NPI:1649659749
Name:KILLGORE, KAREN SUE
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:SUE
Last Name:KILLGORE
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 1:2414 FOXCROFT RD NW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-1381
Mailing Address - Country:US
Mailing Address - Phone:252-299-6099
Mailing Address - Fax:
Practice Address - Street 1:2414 FOXCROFT RD NW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-1381
Practice Address - Country:US
Practice Address - Phone:252-299-6099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4644225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist