Provider Demographics
NPI:1891495628
Name:GREGG, CAITLIN (MLMT)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:GREGG
Suffix:
Gender:F
Credentials:MLMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 JOSEPH ST
Mailing Address - Street 2:
Mailing Address - City:TUPPER LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12986-1810
Mailing Address - Country:US
Mailing Address - Phone:585-278-7264
Mailing Address - Fax:
Practice Address - Street 1:169 OLD MILITARY RD
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:NY
Practice Address - Zip Code:12946
Practice Address - Country:US
Practice Address - Phone:838-233-9740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029067225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist