Provider Demographics
NPI:1194127605
Name:MCCARTER, KAITLYN ANNA (ATC, LAT)
Entity type:Individual
Prefix:MS
First Name:KAITLYN
Middle Name:ANNA
Last Name:MCCARTER
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 SUNSET CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH WATERBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04061-4674
Mailing Address - Country:US
Mailing Address - Phone:774-571-2443
Mailing Address - Fax:
Practice Address - Street 1:20 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-2110
Practice Address - Country:US
Practice Address - Phone:207-282-1596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT4212255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer