Provider Demographics
NPI:1922587161
Name:BOSCH, KAITLYN ELIZABETH ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ELIZABETH ANN
Last Name:BOSCH
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 1:3500 RUEMMELE RD APT 212
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6091
Mailing Address - Country:US
Mailing Address - Phone:701-870-1091
Mailing Address - Fax:
Practice Address - Street 1:2200 LIBRARY CIR
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6326
Practice Address - Country:US
Practice Address - Phone:701-757-2155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1659225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist