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General NPI Number Information
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NPI Number | 1750947586
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Entity Type | Individual
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Provider Name | KAITLYN MALONEY MS. ED., ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 05/16/2019
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Last Update Date | 05/16/2019
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Provider Practice Location Address
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Address Line | 125 JAN LN APT 2
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City | DE SOTO
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State | IL
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Zip | 62924-0045
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Country | US
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Telephone | 302-353-6468
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Fax |
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Provider Business Mailing Address
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Address Line | 125 JAN LN APT 2
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City | DE SOTO
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State | IL
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Zip | 62924-0045
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Country | US
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Telephone | 302-353-6468
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Fax |
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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 | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 2000017799
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License Number State | IL
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