Provider Demographics
NPI:1790092401
Name:WHITAKER, CAITLIN RAE (MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:RAE
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 TIMBER CREST CT
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-3953
Mailing Address - Country:US
Mailing Address - Phone:912-293-1161
Mailing Address - Fax:
Practice Address - Street 1:35 TIMBER CREST CT
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-3953
Practice Address - Country:US
Practice Address - Phone:912-293-1161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist