Provider Demographics
NPI:1952817413
Name:LEFEVRE, CAITLIN ELISABETH (MS, ATC, OTC)
Entity Type:Individual
Prefix:MS
First Name:CAITLIN
Middle Name:ELISABETH
Last Name:LEFEVRE
Suffix:
Gender:F
Credentials:MS, ATC, OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8109 SILVERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43566-9436
Mailing Address - Country:US
Mailing Address - Phone:419-377-8541
Mailing Address - Fax:
Practice Address - Street 1:1000 REGENCY CT STE 212
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3091
Practice Address - Country:US
Practice Address - Phone:567-661-0328
Practice Address - Fax:419-720-0022
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2000009463207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine