Provider Demographics
NPI:1184033318
Name:HALL, CAITLIN TAYLOR (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:TAYLOR
Last Name:HALL
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 BARNETT RD
Mailing Address - Street 2:APT. 628
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310-1725
Mailing Address - Country:US
Mailing Address - Phone:254-291-2492
Mailing Address - Fax:
Practice Address - Street 1:3410 TAFT BLVD
Practice Address - Street 2:D.L. LIGON COLISEUM 159
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2036
Practice Address - Country:US
Practice Address - Phone:940-397-4848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT53202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer