Provider Demographics
NPI:1770075038
Name:GANSERT, CAITLIN ROSE (OTR)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:ROSE
Last Name:GANSERT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:
Other - Last Name:MARIORENZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 RANDALL SQ STE 302
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-2773
Mailing Address - Country:US
Mailing Address - Phone:401-443-5202
Mailing Address - Fax:
Practice Address - Street 1:1 RANDALL SQ STE 302
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2773
Practice Address - Country:US
Practice Address - Phone:401-443-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-03
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
RIOT01933225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist