Healthcare Provider Details

I. General information

NPI: 1447758339
Provider Name (Legal Business Name): KAITLYN IRENE PAYTON MSOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLYN IRENE GUNKEL

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 N GRANDVIEW BLVD STE 100
PEWAUKEE WI
53072-5546
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 262-574-1100
  • Fax: 262-574-5193
Mailing address:
  • Phone: 866-370-8206
  • Fax: 517-435-3670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6164
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: