Provider Demographics
NPI:1376016022
Name:MITCHELL, CAITLYN M (COTA/L)
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:M
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18755 ROSEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-1092
Mailing Address - Country:US
Mailing Address - Phone:708-826-5962
Mailing Address - Fax:
Practice Address - Street 1:12450 WALKER RD
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-9301
Practice Address - Country:US
Practice Address - Phone:630-243-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-05
Last Update Date:2019-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant