Provider Demographics
NPI:1417589961
Name:WOOD, KAITLYN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:WOOD
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:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:BASSETT
Mailing Address - State:VA
Mailing Address - Zip Code:24055-0208
Mailing Address - Country:US
Mailing Address - Phone:276-622-3636
Mailing Address - Fax:276-627-0060
Practice Address - Street 1:935 FAIRYSTONE PARK HWY
Practice Address - Street 2:
Practice Address - City:STANLEYTOWN
Practice Address - State:VA
Practice Address - Zip Code:24168-3014
Practice Address - Country:US
Practice Address - Phone:276-622-3636
Practice Address - Fax:276-627-0060
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119008472225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist