Provider Demographics
NPI:1316393127
Name:CORTESE, KAITLIN (MS OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:
Last Name:CORTESE
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3851 COMMERCIAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-4146
Mailing Address - Country:US
Mailing Address - Phone:843-314-5434
Mailing Address - Fax:888-510-9156
Practice Address - Street 1:3851 COMMERCIAL CENTER DR
Practice Address - Street 2:
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-4146
Practice Address - Country:US
Practice Address - Phone:843-314-5434
Practice Address - Fax:888-510-9156
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006873225X00000X
SC5157225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist