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General NPI Number Information
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NPI Number | 1710884788
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Entity Type | Individual
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Provider Name | KAITLIN GRACE PHAN OTR/L
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Gender | Female
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Dates
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Enumeration Date | 10/22/2026
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Last Update Date | 10/22/2026
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Provider Practice Location Address
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Address Line | 90 HOWARD DR
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City | SHELBYVILLE
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State | KY
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Zip | 40065-8138
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Country | US
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Telephone | 502-233-9074
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Fax | 502-272-9175
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Provider Business Mailing Address
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Address Line | 90 HOWARD DR
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City | SHELBYVILLE
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State | KY
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Zip | 40065-8138
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Country | US
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Telephone | 502-233-9074
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Fax | 502-272-9175
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 312068
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License Number State | KY
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