Provider Demographics
NPI:1245648526
Name:DONNER, KAITLIN SHIVER
Entity type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:SHIVER
Last Name:DONNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 HIGHWAY A1A APT 302
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-5426
Mailing Address - Country:US
Mailing Address - Phone:321-961-3805
Mailing Address - Fax:
Practice Address - Street 1:307 E NEW HAVEN AVE STE 2
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4576
Practice Address - Country:US
Practice Address - Phone:321-953-3991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist