Provider Demographics
NPI:1538813563
Name:LLOYD, KAITLYNN MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:KAITLYNN
Middle Name:MARIE
Last Name:LLOYD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23661 135TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-8675
Mailing Address - Country:US
Mailing Address - Phone:763-645-7280
Mailing Address - Fax:
Practice Address - Street 1:1717 UNIVERSITY DR SE
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56304-2023
Practice Address - Country:US
Practice Address - Phone:320-251-9120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106748225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist