Provider Demographics
NPI:1265146021
Name:STEAVENSON, KAITLIN (PT)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:STEAVENSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:
Other - Last Name:BAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:990 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:WI
Mailing Address - Zip Code:54002
Mailing Address - Country:US
Mailing Address - Phone:715-629-1888
Mailing Address - Fax:
Practice Address - Street 1:990 MAIN STREET
Practice Address - Street 2:#1
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002
Practice Address - Country:US
Practice Address - Phone:715-928-9898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000OtherN/A