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NPI Code Detail

MEDICARE: KAITLYN MARY LEIGH NELSON

MEDICARE:   KAITLYN MARY LEIGH NELSON
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
1225200000XPhysical Therapy Assistant

General Provider Information

NPI Number : 1245966548
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAITLYN MARY LEIGH NELSON
Provider Business Mailing Address
First Line : 200 W DOUGLAS AVE STE 250
Second Line :
City : WICHITA
State : KS
Zip : 67202-3002
Country : US
Telephone Number : 316-263-0003
Fax Number :
Provider Business Practice Location Address
First Line : 1410 N WOODLAWN BLVD STE D
Second Line :
City : DERBY
State : KS
Zip : 67037-2931
Country : US
Telephone Number : 316-202-0970
Fax Number : 316-202-0971
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2022
Last Update Date : 07/28/2022

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Directions to “ KAITLYN MARY LEIGH NELSON ” Practice Location

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