Provider Demographics
NPI:1750166260
Name:PRESCOTT, KAITLYN LEE (OT)
Entity type:Individual
Prefix:MS
First Name:KAITLYN
Middle Name:LEE
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:KAITLYN
Other - Middle Name:LEE
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2801 S WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-2894
Mailing Address - Country:US
Mailing Address - Phone:920-337-1121
Mailing Address - Fax:920-337-1126
Practice Address - Street 1:2801 S WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-2894
Practice Address - Country:US
Practice Address - Phone:920-337-1121
Practice Address - Fax:920-337-1126
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8385-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist