Provider Demographics
NPI:1295191724
Name:SHARMAN, CAITLIN (MS, ATC, PTA)
Entity Type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:
Last Name:SHARMAN
Suffix:
Gender:F
Credentials:MS, ATC, PTA
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:
Other - Last Name:KETCHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:196 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-1651
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 CARTER RD
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1092
Practice Address - Country:US
Practice Address - Phone:315-781-0402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014025225200000X
NY002775-012255A2300X
NY0027752255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant