Provider Demographics
NPI:1942377510
Name:DAVIS, KAITLYN J (OTD)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:J
Last Name:DAVIS
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6906 MASON HILL RD
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-6411
Mailing Address - Country:US
Mailing Address - Phone:847-651-8083
Mailing Address - Fax:
Practice Address - Street 1:6906 MASON HILL RD
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-6411
Practice Address - Country:US
Practice Address - Phone:847-651-8083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL56007676225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics