Individual
COURTNEY KILLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1120 E MAIN ST, SUITE 1, PHILADELPHIA, MS 39350-2300
(601) 663-1275
Mailing address
4109 HIGHWAY 98 W, SUMMIT, MS 39666-9132
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
TA2441
MS
Other
Enumeration date
05/04/2011
Last updated
07/03/2013
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