Provider Demographics
NPI:1295532950
Name:KEMP, KAITLIN ELIZABETH (MBA, MT-BC)
Entity type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:ELIZABETH
Last Name:KEMP
Suffix:
Gender:
Credentials:MBA, MT-BC
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:ELIZABETH
Other - Last Name:BLACKLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT-BC
Mailing Address - Street 1:3414 CARICA DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-6504
Mailing Address - Country:US
Mailing Address - Phone:317-670-2069
Mailing Address - Fax:
Practice Address - Street 1:3414 CARICA DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-6504
Practice Address - Country:US
Practice Address - Phone:317-670-2069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11106225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist