Healthcare Provider Details

I. General information

NPI: 1154843381
Provider Name (Legal Business Name): KAITLYN DANIELLE MARTIN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2017
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 COLONY CROSSING WAY STE 820
MADISON MS
39110-6330
US

IV. Provider business mailing address

920 MUNICIPAL DR
BRANDON MS
39042-2973
US

V. Phone/Fax

Practice location:
  • Phone: 769-289-2890
  • Fax: 769-289-2891
Mailing address:
  • Phone: 601-724-8886
  • Fax: 601-724-8887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT3385
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: