Provider Demographics
NPI:1942874474
Name:MOORE, KAITLYN PAIGE
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:PAIGE
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:TROJANOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50726 WOODBURY DR
Mailing Address - Street 2:
Mailing Address - City:NEW BALTIMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48047-4391
Mailing Address - Country:US
Mailing Address - Phone:586-569-9560
Mailing Address - Fax:
Practice Address - Street 1:50726 WOODBURY DR
Practice Address - Street 2:
Practice Address - City:NEW BALTIMORE
Practice Address - State:MI
Practice Address - Zip Code:48047-4391
Practice Address - Country:US
Practice Address - Phone:586-569-9560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator