Healthcare Provider Details

I. General information

NPI: 1417885013
Provider Name (Legal Business Name): KAITLYN LEANNE LORD OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 S LINCOLN RD
ESCANABA MI
49829-2100
US

IV. Provider business mailing address

5355 PORTAGE POINT 11.4 LN
ESCANABA MI
49829-9672
US

V. Phone/Fax

Practice location:
  • Phone: 906-786-5181
  • Fax:
Mailing address:
  • Phone: 906-399-8197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: