Provider Demographics
NPI:1184070773
Name:MAINA, CAROLINE WAHITO
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:WAHITO
Last Name:MAINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 AUNA DR
Mailing Address - Street 2:APT 8
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-3674
Mailing Address - Country:US
Mailing Address - Phone:978-328-9166
Mailing Address - Fax:857-999-3911
Practice Address - Street 1:30 AUNA DR
Practice Address - Street 2:APT 8
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-3674
Practice Address - Country:US
Practice Address - Phone:978-328-9166
Practice Address - Fax:857-999-3911
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9118225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant