Provider Demographics
NPI:1982064523
Name:REID, CAITLIN (OTRL)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 NORFLEET ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851-1452
Mailing Address - Country:US
Mailing Address - Phone:757-556-1403
Mailing Address - Fax:
Practice Address - Street 1:500 NORFLEET ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-1452
Practice Address - Country:US
Practice Address - Phone:757-556-1403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15218174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist