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NPI Code Detail

MEDICARE: KAITLYN LAVILLE OTD, OTR

MEDICARE: KAITLYN LAVILLE OTD, OTR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist

General Provider Information

NPI Number : 1730869835
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAITLYN LAVILLE OTD, OTR
Provider Business Mailing Address
First Line : 180 PATRIOTS POINT RD APT 502
Second Line :
City : MOUNT PLEASANT
State : SC
Zip : 29464-5437
Country : US
Telephone Number : 703-615-1312
Fax Number :
Provider Business Practice Location Address
First Line : 2387 LANTERN ST
Second Line :
City : CHARLESTON
State : SC
Zip : 29414-4850
Country : US
Telephone Number : 317-750-9879
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2023
Last Update Date : 11/06/2024

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