Provider Demographics
NPI:1598275778
Name:BOTHWELL, KAITLYN CAYCEE
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:CAYCEE
Last Name:BOTHWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:DWIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7557 CONNOR CV APT 203
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2030
Mailing Address - Country:US
Mailing Address - Phone:480-332-5795
Mailing Address - Fax:
Practice Address - Street 1:7557 CONNOR CV APT 203
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2030
Practice Address - Country:US
Practice Address - Phone:480-332-5795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist