Provider Demographics
NPI:1437566304
Name:TITEMORE, KAITLIN MARIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:MARIE
Last Name:TITEMORE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:MARIE
Other - Last Name:WESTERMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:180 HORSESHOE DR
Mailing Address - Street 2:
Mailing Address - City:PALMERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18071-6218
Mailing Address - Country:US
Mailing Address - Phone:610-984-3311
Mailing Address - Fax:
Practice Address - Street 1:401 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:SCHUYLKILL HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17972-2211
Practice Address - Country:US
Practice Address - Phone:570-385-0331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-12
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP007915224Z00000X
PA329011224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant