Provider Demographics
NPI:1942890827
Name:CARDONA, KAITLYN ROSE (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:ROSE
Last Name:CARDONA
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:MAIDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28650-1631
Mailing Address - Country:US
Mailing Address - Phone:203-641-5992
Mailing Address - Fax:
Practice Address - Street 1:208 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:MAIDEN
Practice Address - State:NC
Practice Address - Zip Code:28650-1631
Practice Address - Country:US
Practice Address - Phone:203-641-5992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13818225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist