Provider Demographics
NPI:1528336799
Name:LAVIN, KAITLIN BLIGH (ATC, L)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:BLIGH
Last Name:LAVIN
Suffix:
Gender:F
Credentials:ATC, L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2743
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-2743
Mailing Address - Country:US
Mailing Address - Phone:970-569-3240
Mailing Address - Fax:970-569-3260
Practice Address - Street 1:1140 EDWARDS VILLAGE
Practice Address - Street 2:B-105
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632
Practice Address - Country:US
Practice Address - Phone:970-569-3240
Practice Address - Fax:970-569-3260
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT-9852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer