Provider Demographics
NPI:1083358915
Name:HODGE, KAITLYN (OT)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:HODGE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:251 JOHNSTON ST SE STE 200
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-2515
Mailing Address - Country:US
Mailing Address - Phone:256-350-1764
Mailing Address - Fax:
Practice Address - Street 1:42465 HIGHWAY 195
Practice Address - Street 2:
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565-7052
Practice Address - Country:US
Practice Address - Phone:205-486-2753
Practice Address - Fax:205-486-2109
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALOT5861225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist