MEDICARE: KAITLYN KOITHAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant		NY

General Provider Information

NPI Number	:	1124516828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN KOITHAN

Provider Business Mailing Address
First Line	:	6780 SHAWNEE RD
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-9504
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6780 SHAWNEE RD
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-9504
Country	:	US
Telephone Number	:	716-525-2761
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2018
Last Update Date	:	04/27/2018

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Directions to “ KAITLYN KOITHAN ” Practice Location

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