Provider Demographics
NPI:1790208320
Name:WRIGHT, KAITLYN ELIZABETH (OTR/L)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ELIZABETH
Last Name:WRIGHT
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 1:2162 SERPENTINE CIR S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-6008
Mailing Address - Country:US
Mailing Address - Phone:813-317-0613
Mailing Address - Fax:
Practice Address - Street 1:2005 E GREENVILLE ST STE 119
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1575
Practice Address - Country:US
Practice Address - Phone:864-233-5128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT17963225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist