Provider Demographics
NPI:1043992522
Name:WYLIE, KAITLIN (OTR/L)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:WYLIE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 TRENTON RD # E123
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-5674
Mailing Address - Country:US
Mailing Address - Phone:267-981-4797
Mailing Address - Fax:
Practice Address - Street 1:800 TRENTON RD # E123
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-5674
Practice Address - Country:US
Practice Address - Phone:267-981-4797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01032700225X00000X
PAOC018007225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist