Provider Demographics
NPI:1962243741
Name:SEYMOUR, KAITLYNN JANE (DPT, MAT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:KAITLYNN
Middle Name:JANE
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:DPT, MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 DUTCH RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:NC
Mailing Address - Zip Code:28124-8726
Mailing Address - Country:US
Mailing Address - Phone:980-521-2683
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 261954
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29528-6054
Practice Address - Country:US
Practice Address - Phone:980-521-2683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAT032442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer