Provider Demographics
NPI:1477242766
Name:MAITRE, CAITLIN JEANETTE (OT/L)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:JEANETTE
Last Name:MAITRE
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9350 SW 183RD TER
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5772
Mailing Address - Country:US
Mailing Address - Phone:317-417-7435
Mailing Address - Fax:
Practice Address - Street 1:9350 SW 183RD TER
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-5772
Practice Address - Country:US
Practice Address - Phone:317-417-7435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT16252225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist