Individual
LISA KILGORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1316 LANVALE DR, SAINT LOUIS, MO 63119-4711
(479) 640-8669
Mailing address
1316 LANVALE DR, SAINT LOUIS, MO 63119-4711
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2015027459
MO
Other
Enumeration date
12/29/2015
Last updated
12/29/2015
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