Provider Demographics
NPI:1598443509
Name:COREY, KAITLYN (OTD)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:COREY
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 MICHELE LN
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-8235
Mailing Address - Country:US
Mailing Address - Phone:781-690-4840
Mailing Address - Fax:
Practice Address - Street 1:277 ELLIOT ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02464-1201
Practice Address - Country:US
Practice Address - Phone:617-527-0023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA901075506225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist