Healthcare Provider Details

I. General information

NPI: 1720924640
Provider Name (Legal Business Name): KAITLYN LITTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S LAFAYETTE ST
MACOMB IL
61455-2289
US

IV. Provider business mailing address

9460 N 2100TH RD
SCIOTA IL
61475-8426
US

V. Phone/Fax

Practice location:
  • Phone: 309-837-3911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160006645
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: