Provider Demographics
NPI:1780242669
Name:JEFFERIS, CAITLIN NICOLE (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:NICOLE
Last Name:JEFFERIS
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9150 W INDIAN SCHOOL RD STE 105
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-2385
Mailing Address - Country:US
Mailing Address - Phone:480-787-5387
Mailing Address - Fax:623-232-3250
Practice Address - Street 1:9150 W INDIAN SCHOOL RD STE 105
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-2385
Practice Address - Country:US
Practice Address - Phone:480-787-5387
Practice Address - Fax:623-232-3250
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2020-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT20075225X00000X
AZOTH-008198225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist