Healthcare Provider Details

I. General information

NPI: 1598374126
Provider Name (Legal Business Name): KAITLYN JEAN ELYSEE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 WASHINGTON ST
WALPOLE MA
02081-2404
US

IV. Provider business mailing address

76 POUTS LN
UXBRIDGE MA
01569-2182
US

V. Phone/Fax

Practice location:
  • Phone: 508-208-8438
  • Fax:
Mailing address:
  • Phone: 774-318-0402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number15031
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH-008205
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: