Provider Demographics
NPI:1295433092
Name:DAVIS, KAITLYN N (DPT)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:N
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14025 N EASTERN AVE APT 2016
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5772
Mailing Address - Country:US
Mailing Address - Phone:316-209-6021
Mailing Address - Fax:
Practice Address - Street 1:5025 GAILLARDIA CORPORATE PL
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-1888
Practice Address - Country:US
Practice Address - Phone:405-753-9064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6288225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist