Provider Demographics
NPI:1417558354
Name:UTZ, KAITLYN (MS)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:UTZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 W BURKE ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2709
Mailing Address - Country:US
Mailing Address - Phone:304-596-1001
Mailing Address - Fax:
Practice Address - Street 1:709 W BURKE ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2709
Practice Address - Country:US
Practice Address - Phone:304-901-5172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator