Provider Demographics
NPI:1407000318
Name:YENGO, CAITLIN M (MSOTR/L)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:M
Last Name:YENGO
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:M
Other - Last Name:GAMBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSOTR/L
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:DEPARTMENT OF PHYSICAL AND OCCUPATIONAL THERAPY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-7212
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:DEPARTMENT OF PHYSICAL AND OCCUPATIONAL THERAPY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-7212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011770-01225X00000X
MA11243225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist