Provider Demographics
NPI:1063703577
Name:KILMER, JOHN PAUL (OTR/L)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PAUL
Last Name:KILMER
Suffix:
Gender:M
Credentials:OTR/L
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 48462
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99228-1462
Mailing Address - Country:US
Mailing Address - Phone:509-638-9177
Mailing Address - Fax:
Practice Address - Street 1:11850 NICHOLAS ST STE 100
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4476
Practice Address - Country:US
Practice Address - Phone:402-505-4670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-975225X00000X
WAOT002923225X00000X
CAOT 10244225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist