Provider Demographics
NPI:1043556814
Name:FEALKO, CAITLIN STALLINGS (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:STALLINGS
Last Name:FEALKO
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 1:3026 WALTON WAY EXT
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-3442
Mailing Address - Country:US
Mailing Address - Phone:478-957-1160
Mailing Address - Fax:
Practice Address - Street 1:444 PARK WEST DR
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-3216
Practice Address - Country:US
Practice Address - Phone:706-868-6543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-22
Last Update Date:2012-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005555225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist