Provider Demographics
NPI:1376315564
Name:KAUFMAN, KAITLIN (LMT)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 DORCHESTER RD APT 2M
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-6748
Mailing Address - Country:US
Mailing Address - Phone:516-547-5555
Mailing Address - Fax:
Practice Address - Street 1:1801 DORCHESTER RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-6755
Practice Address - Country:US
Practice Address - Phone:516-547-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032773225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist