Provider Demographics
NPI:1528881505
Name:SHEVLIN, KAITLYNN MARIE
Entity type:Individual
Prefix:
First Name:KAITLYNN
Middle Name:MARIE
Last Name:SHEVLIN
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 1:2004 BRIAR WOODS LN
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-7437
Mailing Address - Country:US
Mailing Address - Phone:914-602-6672
Mailing Address - Fax:
Practice Address - Street 1:2004 BRIAR WOODS LN
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-7437
Practice Address - Country:US
Practice Address - Phone:914-602-6672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011197224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant