Provider Demographics
NPI:1942659164
Name:GAUL, CAITLYN (ATC, CCMA)
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:
Last Name:GAUL
Suffix:
Gender:F
Credentials:ATC, CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 SW 30TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97331-8629
Mailing Address - Country:US
Mailing Address - Phone:541-768-7700
Mailing Address - Fax:541-768-9784
Practice Address - Street 1:845 SW 30TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97331-8629
Practice Address - Country:US
Practice Address - Phone:541-768-7700
Practice Address - Fax:541-768-9784
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2858292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer