Provider Demographics
NPI:1255014379
Name:RODDY, KAITLYN (OTR/L)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:RODDY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:SPEARS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1440 PETERMAN DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3432
Mailing Address - Country:US
Mailing Address - Phone:318-278-0740
Mailing Address - Fax:
Practice Address - Street 1:1440 PETERMAN DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3432
Practice Address - Country:US
Practice Address - Phone:318-278-0740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA338112225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist