Provider Demographics
NPI:1982099610
Name:CAVANAUGH, CAITLIN JEAN (MS, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:CAITLIN
Middle Name:JEAN
Last Name:CAVANAUGH
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 13TH AVE. APT 12
Mailing Address - Street 2:
Mailing Address - City:BELMAR
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-2460
Mailing Address - Country:US
Mailing Address - Phone:908-433-1760
Mailing Address - Fax:
Practice Address - Street 1:207 13TH AVE APT 12
Practice Address - Street 2:
Practice Address - City:BELMAR
Practice Address - State:NJ
Practice Address - Zip Code:07719-2460
Practice Address - Country:US
Practice Address - Phone:908-433-1760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00589300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist