Provider Demographics
NPI:1174315758
Name:COSTELLO, KAITLIN VERONICA ANNE (OTR/L)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:VERONICA ANNE
Last Name:COSTELLO
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 1:921 SANDY LN
Mailing Address - Street 2:
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-2643
Mailing Address - Country:US
Mailing Address - Phone:215-620-9216
Mailing Address - Fax:
Practice Address - Street 1:921 SANDY LN
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-2643
Practice Address - Country:US
Practice Address - Phone:215-620-9216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC020745225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist