Provider Demographics
NPI:1831956374
Name:BOHAN, KAITLIN ROSE (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:ROSE
Last Name:BOHAN
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7333 INTERNATIONAL PL
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34240-8418
Mailing Address - Country:US
Mailing Address - Phone:941-500-2333
Mailing Address - Fax:
Practice Address - Street 1:7333 INTERNATIONAL PL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34240-8418
Practice Address - Country:US
Practice Address - Phone:941-500-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24909225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist