Healthcare Provider Details

I. General information

NPI: 1982550133
Provider Name (Legal Business Name): KAITLIN ELLIOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 W BOYLSTON ST
WEST BOYLSTON MA
01583-1784
US

IV. Provider business mailing address

52 SURREY LN
HOLDEN MA
01520-1528
US

V. Phone/Fax

Practice location:
  • Phone: 800-244-4691
  • Fax:
Mailing address:
  • Phone: 774-420-9210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: