Provider Demographics
NPI:1700362134
Name:PLOEGER, KAITLIN JOY (OTD OTR/L)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:JOY
Last Name:PLOEGER
Suffix:
Gender:F
Credentials:OTD OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3012 BODEGA BAY ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2255
Mailing Address - Country:US
Mailing Address - Phone:702-595-2753
Mailing Address - Fax:
Practice Address - Street 1:653 N TOWN CENTER DR STE 507
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0519
Practice Address - Country:US
Practice Address - Phone:702-697-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17-0931225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty