Provider Demographics
NPI:1427401751
Name:GASPER, KAITLIN NOEL (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:NOEL
Last Name:GASPER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4883 DRESSLER RD NW STE 203
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3666
Mailing Address - Country:US
Mailing Address - Phone:888-627-3678
Mailing Address - Fax:
Practice Address - Street 1:10903 GRAVELLY LAKE DR SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-1341
Practice Address - Country:US
Practice Address - Phone:253-583-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60668968225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist