Provider Demographics
NPI:1013806678
Name:DITMARS, KAITLYN MAE
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MAE
Last Name:DITMARS
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 1:2359 COUNTY ROAD 19
Mailing Address - Street 2:
Mailing Address - City:CORUNNA
Mailing Address - State:IN
Mailing Address - Zip Code:46730-9711
Mailing Address - Country:US
Mailing Address - Phone:260-624-5560
Mailing Address - Fax:
Practice Address - Street 1:500 ACADEMY ST S
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3248
Practice Address - Country:US
Practice Address - Phone:252-209-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17748225X00000X
IN31008760A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist