Provider Demographics
NPI:1972296275
Name:DITTIGER, KAITLIN A
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:A
Last Name:DITTIGER
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 1:800 HERTEL AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14207-1906
Mailing Address - Country:US
Mailing Address - Phone:716-566-5050
Mailing Address - Fax:
Practice Address - Street 1:800 HERTEL AVE STE 101
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14207-1906
Practice Address - Country:US
Practice Address - Phone:716-566-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027967-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist