Provider Demographics
NPI:1770966517
Name:BAXTER, CAITLYN JEAN (LMT)
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:JEAN
Last Name:BAXTER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CAITLYN
Other - Middle Name:JEAN
Other - Last Name:BORUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:108 E ARCTIC AVE
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6254
Mailing Address - Country:US
Mailing Address - Phone:907-745-4357
Mailing Address - Fax:907-745-4606
Practice Address - Street 1:108 E ARCTIC AVE
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6254
Practice Address - Country:US
Practice Address - Phone:907-745-4357
Practice Address - Fax:907-745-4606
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-29
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
AK101482225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist