Provider Demographics
NPI:1841707767
Name:ALLISON, CAITLIN NICOLE (ATC)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:NICOLE
Last Name:ALLISON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 I ST NE
Mailing Address - Street 2:ATTN: ATHLETIC TRAINING
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 I ST NE
Practice Address - Street 2:ATTN: ATHLETIC TRAINING
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354
Practice Address - Country:US
Practice Address - Phone:918-594-6323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-30
Last Update Date:2017-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20150036702255A2300X
OK8432255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000017483OtherBOARD OF CERTIFICATION FOR THE ATHLETIC TRAINER
OK843OtherOKLAHOMA MEDICAL BOARD, ATHLETIC TRAINER LICENSE
MO2015003670OtherMISSOURI DIVISION OF PROFESSIONAL REGISTRATION, ATHLETIC TRAINER LICENSE