Provider Demographics
NPI:1366826562
Name:HART, CAITLIN LEE
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:LEE
Last Name:HART
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 1:215 SPENCER PL
Mailing Address - Street 2:APT. 121
Mailing Address - City:CAYCE
Mailing Address - State:SC
Mailing Address - Zip Code:29033-3980
Mailing Address - Country:US
Mailing Address - Phone:540-830-5649
Mailing Address - Fax:
Practice Address - Street 1:215 SPENCER PL
Practice Address - Street 2:APT. 121
Practice Address - City:CAYCE
Practice Address - State:SC
Practice Address - Zip Code:29033-3980
Practice Address - Country:US
Practice Address - Phone:540-830-5649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer