Provider Demographics
NPI:1568935559
Name:WILSON, CAITLYN (MA, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MA, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2984 SIDNEY ST APT 443
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-5156
Mailing Address - Country:US
Mailing Address - Phone:216-401-0368
Mailing Address - Fax:
Practice Address - Street 1:2984 SIDNEY ST APT 443
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203-5156
Practice Address - Country:US
Practice Address - Phone:216-401-0368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0081582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer