Provider Demographics
NPI:1043718596
Name:BREW, KAITLIN (MOTR)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:BREW
Suffix:
Gender:F
Credentials:MOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4606 N COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-5456
Mailing Address - Country:US
Mailing Address - Phone:307-414-8394
Mailing Address - Fax:307-316-8125
Practice Address - Street 1:4606 N COLLEGE DR
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-5456
Practice Address - Country:US
Practice Address - Phone:307-414-8394
Practice Address - Fax:307-316-8125
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist