Provider Demographics
NPI:1871006130
Name:UPTON, KAITLIN HANCOCK (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:HANCOCK
Last Name:UPTON
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:MARIE
Other - Last Name:HANCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:1379 PLAYERS CLUB CIR
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-3521
Mailing Address - Country:US
Mailing Address - Phone:775-367-6937
Mailing Address - Fax:
Practice Address - Street 1:8225 WHIPPS MILL RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5482
Practice Address - Country:US
Practice Address - Phone:775-367-6937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY266639225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist