Provider Demographics
NPI:1679877872
Name:KILIAN, COOKIE (CMT, LPN, CPT)
Entity type:Individual
Prefix:
First Name:COOKIE
Middle Name:
Last Name:KILIAN
Suffix:
Gender:F
Credentials:CMT, LPN, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4891 MILLER TRUNK HWY STE 106
Mailing Address - Street 2:
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811-1579
Mailing Address - Country:US
Mailing Address - Phone:218-481-3370
Mailing Address - Fax:
Practice Address - Street 1:4891 MILLER TRUNK HWY STE 106
Practice Address - Street 2:
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811-1579
Practice Address - Country:US
Practice Address - Phone:218-481-3370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-02
Last Update Date:2020-03-18
Deactivation Date:2014-02-05
Deactivation Code:
Reactivation Date:2020-02-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist