Most Relevant Information
Provider Data
| NPI Number: | 1003254624 |
| Provider Name: | KILEY JOHNSON |
| Entity Type: | Individual |
| Taxonomy Code: | 222Q00000X |
| Specialty: | Developmental Therapist |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/05/2013 |
| Last Updated: | 06/05/2013 |
Provider Practice Location
500 ANCHOR RD
DIXON
IL
610218829
Practice Location Phone/Fax
| Phone: | 8152886691 |
| Fax: |
Provider Mailing Location
500 ANCHOR RD
DIXON
IL
610218829
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |