Provider Demographics
NPI:1306312780
Name:HARMON, KAITLYN ABIGAIL (COTA)
Entity type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:ABIGAIL
Last Name:HARMON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MS
Other - First Name:KAITLYN
Other - Middle Name:ABIGAIL
Other - Last Name:RICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:168 EAST GRANDE AVENUE
Mailing Address - Street 2:APARTMENT 1
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601
Mailing Address - Country:US
Mailing Address - Phone:423-833-7347
Mailing Address - Fax:
Practice Address - Street 1:3209 BRISTOL HWY
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1515
Practice Address - Country:US
Practice Address - Phone:423-282-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3085224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant