Provider Demographics
NPI:1760194922
Name:DEPEW, KAITLYN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:DEPEW
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 1:145 CURTIS AVE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-1702
Mailing Address - Country:US
Mailing Address - Phone:419-494-5482
Mailing Address - Fax:
Practice Address - Street 1:7100 S WILKINSON WAY
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-2590
Practice Address - Country:US
Practice Address - Phone:567-702-4751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT009263225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist