Provider Demographics
NPI:1285833285
Name:MACADAMS, KILA A (OT)
Entity type:Individual
Prefix:
First Name:KILA
Middle Name:A
Last Name:MACADAMS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2469 WESTBORNE DR
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:KY
Mailing Address - Zip Code:41092-9318
Mailing Address - Country:US
Mailing Address - Phone:859-750-8137
Mailing Address - Fax:
Practice Address - Street 1:6099 RIVERSIDE DR STE 207
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2004
Practice Address - Country:US
Practice Address - Phone:740-953-1184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-R1375225X00000X
OHOT2538225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0950320OtherMEDICARE