Provider Demographics
NPI:1629779004
Name:COAKLEY, KAITLYN MARIE
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MARIE
Last Name:COAKLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SCHOOL ST APT 2
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-3471
Mailing Address - Country:US
Mailing Address - Phone:413-657-5980
Mailing Address - Fax:
Practice Address - Street 1:301 EDGEWATER PL
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1293
Practice Address - Country:US
Practice Address - Phone:413-657-5980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician