Provider Demographics
NPI:1750045191
Name:GRIFFIN, CAITLIN MACKENZIE (ATC)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MACKENZIE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 CLEWLEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:ME
Mailing Address - Zip Code:04428-6118
Mailing Address - Country:US
Mailing Address - Phone:207-349-0668
Mailing Address - Fax:
Practice Address - Street 1:101 CIANBRO SQ
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:ME
Practice Address - Zip Code:04967-6301
Practice Address - Country:US
Practice Address - Phone:207-487-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MEAT9072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program