Provider Demographics
NPI:1669135273
Name:ROCK, KAITLYN (OTR/L)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:ROCK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 219297
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64121-9297
Mailing Address - Country:US
Mailing Address - Phone:163-732-8458
Mailing Address - Fax:816-373-2842
Practice Address - Street 1:4460 S NOLAND RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-4743
Practice Address - Country:US
Practice Address - Phone:816-373-2845
Practice Address - Fax:816-373-2842
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021042037225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist