Provider Demographics
NPI:1548951106
Name:ZASTOUPIL, KAITLIN (OTR/L)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:ZASTOUPIL
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 1:3613 JORDAN SHIRES DR
Mailing Address - Street 2:
Mailing Address - City:NEW HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27562-9312
Mailing Address - Country:US
Mailing Address - Phone:352-359-4406
Mailing Address - Fax:
Practice Address - Street 1:4801 EDWARDS MILL RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4417
Practice Address - Country:US
Practice Address - Phone:919-787-0777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15743225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter