=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265242432
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAITLIN YOUNG OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2025
-----------------------------------------------------
Last Update Date | 01/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 SCALLOP SHELL WAY
-----------------------------------------------------
City | WAKEFIELD
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02879-3045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-789-3006
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 76 SHADY COVE RD
-----------------------------------------------------
City | NORTH KINGSTOWN
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02852-7124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-365-8897
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OT01705
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------