Provider Demographics
NPI:1710395256
Name:CARDONE, CAITLIN (COTA/L)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:CARDONE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MISS
Other - First Name:CAITLIN
Other - Middle Name:
Other - Last Name:CARDONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA/L
Mailing Address - Street 1:5300 PATRON PL
Mailing Address - Street 2:APT# 1728
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8094
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:720 OLD CHEROKEE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9406
Practice Address - Country:US
Practice Address - Phone:803-479-1758
Practice Address - Fax:866-464-4298
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3322224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant