Provider Demographics
NPI:1720320187
Name:PETERMAN, KAYTLIN THERESA
Entity Type:Individual
Prefix:MRS
First Name:KAYTLIN
Middle Name:THERESA
Last Name:PETERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KAYTLIN
Other - Middle Name:THERESA
Other - Last Name:CALARCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:627 REGAL ROBIN WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-1236
Mailing Address - Country:US
Mailing Address - Phone:702-426-4327
Mailing Address - Fax:
Practice Address - Street 1:627 REGAL ROBIN WAY
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-1236
Practice Address - Country:US
Practice Address - Phone:702-426-4327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner