Provider Demographics
NPI:1578963419
Name:MASSIE, CAITLYN (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:CAITLYN
Middle Name:
Last Name:MASSIE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MISS
Other - First Name:CAITLYN
Other - Middle Name:ALEXA
Other - Last Name:STAPLETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:425 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PIKETON
Mailing Address - State:OH
Mailing Address - Zip Code:45661-8114
Mailing Address - Country:US
Mailing Address - Phone:740-289-4171
Mailing Address - Fax:
Practice Address - Street 1:425 E 2ND ST
Practice Address - Street 2:
Practice Address - City:PIKETON
Practice Address - State:OH
Practice Address - Zip Code:45661-8114
Practice Address - Country:US
Practice Address - Phone:740-289-4171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.05505224Z00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant