Provider Demographics
NPI:1285906875
Name:MASTERS, KAITLYN DANIELLE (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:DANIELLE
Last Name:MASTERS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:DANIELLE
Other - Last Name:SEMONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:129 CABIN HALLOW RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE ROCK
Mailing Address - State:VA
Mailing Address - Zip Code:24085-3583
Mailing Address - Country:US
Mailing Address - Phone:540-525-3410
Mailing Address - Fax:
Practice Address - Street 1:160 KENDAL DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-1786
Practice Address - Country:US
Practice Address - Phone:540-464-2638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000704224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant