Provider Demographics
NPI:1174028401
Name:ACKERMAN, CAITLIN (OTR/L)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:ACKERMAN
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 1:100 BEARD SAWMILL RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-6150
Mailing Address - Country:US
Mailing Address - Phone:888-860-0868
Mailing Address - Fax:
Practice Address - Street 1:100 BEARD SAWMILL RD
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6150
Practice Address - Country:US
Practice Address - Phone:888-860-0868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4911225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty