Provider Demographics
NPI:1164832895
Name:WISE, KAITLYN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:
Last Name:WISE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2517 EASTLAKE AVE E. #102
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102
Mailing Address - Country:US
Mailing Address - Phone:206-322-5433
Mailing Address - Fax:954-514-1126
Practice Address - Street 1:2517 EASTLAKE AVE E. #102
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102
Practice Address - Country:US
Practice Address - Phone:206-322-5433
Practice Address - Fax:954-514-1126
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16165225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist