Provider Demographics
NPI:1104390673
Name:SPALL, CAITLIN R (RRA)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:R
Last Name:SPALL
Suffix:
Gender:F
Credentials:RRA
Other - Prefix:
Other - First Name:CAITLAIN
Other - Middle Name:
Other - Last Name:SCHAUMBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RRA
Mailing Address - Street 1:9998 CROSSPOINT BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3307
Mailing Address - Country:US
Mailing Address - Phone:317-579-2150
Mailing Address - Fax:317-579-2130
Practice Address - Street 1:9998 CROSSPOINT BLVD STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3307
Practice Address - Country:US
Practice Address - Phone:317-579-2150
Practice Address - Fax:317-579-2130
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INXT016685243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant