Provider Demographics
NPI:1891374849
Name:THONGKHAM, KAITLYN PAIGE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:PAIGE
Last Name:THONGKHAM
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:PAIGE
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2008 CHERRYBARK BND
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72936-4914
Mailing Address - Country:US
Mailing Address - Phone:918-721-1462
Mailing Address - Fax:
Practice Address - Street 1:2010 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-5321
Practice Address - Country:US
Practice Address - Phone:479-471-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1681224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant