Provider Demographics
NPI:1134788326
Name:PATE, KAITLYN DORIS (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:DORIS
Last Name:PATE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:KAITLYN
Other - Middle Name:DORIS
Other - Last Name:LENTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:104 MONTEGA LN
Mailing Address - Street 2:
Mailing Address - City:COXS CREEK
Mailing Address - State:KY
Mailing Address - Zip Code:40013-6655
Mailing Address - Country:US
Mailing Address - Phone:502-504-2257
Mailing Address - Fax:
Practice Address - Street 1:104 MONTEGA LN
Practice Address - Street 2:
Practice Address - City:COXS CREEK
Practice Address - State:KY
Practice Address - Zip Code:40013-6655
Practice Address - Country:US
Practice Address - Phone:502-504-2257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251523225X00000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist