Provider Demographics
NPI:1043853534
Name:KEMP, KAITLIN F
Entity type:Individual
Prefix:MS
First Name:KAITLIN
Middle Name:F
Last Name:KEMP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 KING RICHARD CT
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-5409
Mailing Address - Country:US
Mailing Address - Phone:580-227-0706
Mailing Address - Fax:
Practice Address - Street 1:2114 N ZARAGOZA RD STE C1
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-8129
Practice Address - Country:US
Practice Address - Phone:915-271-8030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2948225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty