MEDICARE: KAITLIN PATE

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	225X00000X	Occupational Therapist	121589	TX

General Provider Information

NPI Number	:	1538745328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN PATE

Provider Business Mailing Address
First Line	:	600 CLEAR SPRING LN
Second Line	:
City	:	LEANDER
State	:	TX
Zip	:	78641-7931
Country	:	US
Telephone Number	:	512-906-9497
Fax Number	:

Provider Business Practice Location Address
First Line	:	17301 I-35 #101
Second Line	:
City	:	BUDA
State	:	TX
Zip	:	78610-7861
Country	:	US
Telephone Number	:	512-994-4115
Fax Number	:

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

Provider Enumeration Date	:	03/22/2021
Last Update Date	:	03/22/2021

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Directions to “ KAITLIN PATE ” Practice Location

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