Provider Demographics
NPI:1033870498
Name:CATERPILLAR PLAYGROUND OCCUPATIONAL AND PHYSICAL THERAPY
Entity Type:Organization
Organization Name:CATERPILLAR PLAYGROUND OCCUPATIONAL AND PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WITTENAUER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:502-299-7837
Mailing Address - Street 1:1372 CONCANNON BLVD
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-6004
Mailing Address - Country:US
Mailing Address - Phone:502-264-9353
Mailing Address - Fax:
Practice Address - Street 1:1372 CONCANNON BLVD
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-6004
Practice Address - Country:US
Practice Address - Phone:502-264-9353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-06
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA19193OtherCALIFORNIA BOARD OF OT
KY355313OtherKENTUCKY BOARD OF LICENSURE FOR OCCUPATIONAL THERAPY
KY1295867810OtherINDIVIDUAL NPI