Provider Demographics
NPI:1699274803
Name:MYERS, KAITLIN ELIZABETH
Entity type:Individual
Prefix:MS
First Name:KAITLIN
Middle Name:ELIZABETH
Last Name:MYERS
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 1:112 NEEDHAM RD
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02136-3318
Mailing Address - Country:US
Mailing Address - Phone:617-862-7628
Mailing Address - Fax:
Practice Address - Street 1:225 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-3045
Practice Address - Country:US
Practice Address - Phone:781-329-0909
Practice Address - Fax:781-320-9136
Is Sole Proprietor?:No
Enumeration Date:2018-02-03
Last Update Date:2018-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist