Provider Demographics
NPI:1316764624
Name:MORROW, KAITLYN DANIELLE
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:DANIELLE
Last Name:MORROW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 LYON RD APT 86
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-7980
Mailing Address - Country:US
Mailing Address - Phone:510-827-9067
Mailing Address - Fax:
Practice Address - Street 1:127 HOSPITAL DR STE 101
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2500
Practice Address - Country:US
Practice Address - Phone:707-552-8795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85122225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist