Provider Demographics
NPI:1932649670
Name:MENGE, CAITLIN (CPO)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:MENGE
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 LATOUCHE ST
Mailing Address - Street 2:STE. 100
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4208
Mailing Address - Country:US
Mailing Address - Phone:907-561-1777
Mailing Address - Fax:
Practice Address - Street 1:3400 LATOUCHE ST
Practice Address - Street 2:STE. 100
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4208
Practice Address - Country:US
Practice Address - Phone:907-561-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist