Healthcare Provider Details

I. General information

NPI: 1740194844
Provider Name (Legal Business Name): KAITLYNN TODD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 KENT LN APT 67C
MYRTLE BEACH SC
29579-3163
US

IV. Provider business mailing address

640 KENT LN APT 67C
MYRTLE BEACH SC
29579-3163
US

V. Phone/Fax

Practice location:
  • Phone: 315-532-0518
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14416
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: