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NPI Code Detail

MEDICARE: KAITLYN ALLEN MS, OTR/L

MEDICARE: KAITLYN ALLEN MS, OTR/L
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
1225X00000XOccupational TherapistOT007180GA

General Provider Information

NPI Number : 1861967903
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAITLYN ALLEN MS, OTR/L
Provider Business Mailing Address
First Line : 3727 EXECUTIVE CENTER DR
Second Line :
City : AUGUSTA
State : GA
Zip : 30907-2398
Country : US
Telephone Number : 706-426-4200
Fax Number :
Provider Business Practice Location Address
First Line : 3727 EXECUTIVE CENTER DR
Second Line :
City : AUGUSTA
State : GA
Zip : 30907-2398
Country : US
Telephone Number : 706-842-5331
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2018
Last Update Date : 10/04/2018

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