Provider Demographics
NPI:1578031928
Name:MOTTA, CAITLIN MCNABB
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MCNABB
Last Name:MOTTA
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 1:401 ANDOVER ST STE 102
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5076
Mailing Address - Country:US
Mailing Address - Phone:978-686-0004
Mailing Address - Fax:
Practice Address - Street 1:401 ANDOVER ST STE 102
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5076
Practice Address - Country:US
Practice Address - Phone:978-686-0004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-04
Last Update Date:2018-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21644225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist