Provider Demographics
NPI:1407588411
Name:ARNOLD, KAITLYN GRICE (OTR)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:GRICE
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 ANDREWS PKWY APT 2158
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-2963
Mailing Address - Country:US
Mailing Address - Phone:318-557-8790
Mailing Address - Fax:
Practice Address - Street 1:900 JUNCTION DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5290
Practice Address - Country:US
Practice Address - Phone:469-675-3153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122799225XP0200X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist