Provider Demographics
NPI:1982305074
Name:YEAGLEY, KAITLYN (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:YEAGLEY
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:MILLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:5191 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-9137
Mailing Address - Country:US
Mailing Address - Phone:231-946-1979
Mailing Address - Fax:231-946-1984
Practice Address - Street 1:5191 ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49685-9137
Practice Address - Country:US
Practice Address - Phone:231-946-1979
Practice Address - Fax:231-946-1984
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201011640225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist