Provider Demographics
NPI:1821584277
Name:DOYLE, KAITLIN JULIA (BA, ATC)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:JULIA
Last Name:DOYLE
Suffix:
Gender:F
Credentials:BA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14818 QUAMBA ST NE
Mailing Address - Street 2:
Mailing Address - City:HAM LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55304-6338
Mailing Address - Country:US
Mailing Address - Phone:763-370-9296
Mailing Address - Fax:
Practice Address - Street 1:4200 DAHLBERG DR
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4840
Practice Address - Country:US
Practice Address - Phone:952-388-0251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20000227512255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer