Provider Demographics
NPI:1730869835
Name:LAVILLE, KAITLYN (OTD, OTR)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:LAVILLE
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 PATRIOTS POINT RD APT 502
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-5437
Mailing Address - Country:US
Mailing Address - Phone:703-615-1312
Mailing Address - Fax:
Practice Address - Street 1:2387 LANTERN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-4850
Practice Address - Country:US
Practice Address - Phone:317-750-9879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist