Provider Demographics
NPI:1679882773
Name:SOLOMON MCKILLOP, ILENE CAREN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ILENE
Middle Name:CAREN
Last Name:SOLOMON MCKILLOP
Suffix:
Gender:F
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 1:3 SHERWOOD CRES
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6458
Mailing Address - Country:US
Mailing Address - Phone:516-410-0295
Mailing Address - Fax:631-254-2577
Practice Address - Street 1:3 SHERWOOD CRES
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-6458
Practice Address - Country:US
Practice Address - Phone:516-410-0295
Practice Address - Fax:631-254-2577
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003930-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics