Provider Demographics
NPI:1669019576
Name:THOMPSON, KAITLIN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 SW ANKENY RD
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-5999
Mailing Address - Country:US
Mailing Address - Phone:515-289-9696
Mailing Address - Fax:515-289-9649
Practice Address - Street 1:2854 CORAL COURT, STE 1
Practice Address - Street 2:ON WITH LIFE OUTPATIENT NEURO REHABILITATION
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2809
Practice Address - Country:US
Practice Address - Phone:319-259-6224
Practice Address - Fax:319-249-6643
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA084085225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA42-1308032Medicaid