Provider Demographics
NPI:1053562249
Name:KILDAY, JAMES EDWARD (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:KILDAY
Suffix:
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21802 MICHIGAN LN
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1911
Mailing Address - Country:US
Mailing Address - Phone:949-395-7044
Mailing Address - Fax:
Practice Address - Street 1:21802 MICHIGAN LN
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1911
Practice Address - Country:US
Practice Address - Phone:949-395-7044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9983225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist