Individual
KAITLIN DICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
10 FOUNTAINVIEW TER, GREENVILLE, SC 29607-4060
(864) 528-5507
Mailing address
10 FOUNTAINVIEW TER, GREENVILLE, SC 29607-4060
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
3279
SC
Other
Enumeration date
01/30/2014
Last updated
01/30/2014
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