Provider Demographics
NPI:1720545890
Name:MCKEON, KAITLIN LEE (ATC)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:LEE
Last Name:MCKEON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15932 CRESTROCK CIR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-2546
Mailing Address - Country:US
Mailing Address - Phone:303-803-8403
Mailing Address - Fax:
Practice Address - Street 1:6300 S LEWISTON WAY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-3006
Practice Address - Country:US
Practice Address - Phone:303-269-8176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20000251042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer