Healthcare Provider Details

I. General information

NPI: 1326942244
Provider Name (Legal Business Name): KAITLAN OLIVIA NELSON MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 BLOOMING GROVE TPKE
NEW WINDSOR NY
12553-8135
US

IV. Provider business mailing address

903 LYMAN AVE
PEEKSKILL NY
10566-1819
US

V. Phone/Fax

Practice location:
  • Phone: 845-527-2089
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: