Provider Demographics
NPI:1447758339
Name:PAYTON, KAITLYN IRENE (MSOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:IRENE
Last Name:PAYTON
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:IRENE
Other - Last Name:GUNKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:866-370-8206
Mailing Address - Fax:517-435-3670
Practice Address - Street 1:2835 N GRANDVIEW BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-5546
Practice Address - Country:US
Practice Address - Phone:262-574-1100
Practice Address - Fax:262-574-5193
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6164225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100074872Medicaid