Provider Demographics
NPI:1093409831
Name:KRAVICK, CAITLIN MOOREA
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MOOREA
Last Name:KRAVICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 CHICAGO ST
Mailing Address - Street 2:
Mailing Address - City:KIEL
Mailing Address - State:WI
Mailing Address - Zip Code:53042-1228
Mailing Address - Country:US
Mailing Address - Phone:608-369-3358
Mailing Address - Fax:
Practice Address - Street 1:129 CHICAGO ST
Practice Address - Street 2:
Practice Address - City:KIEL
Practice Address - State:WI
Practice Address - Zip Code:53042-1228
Practice Address - Country:US
Practice Address - Phone:608-369-3358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program