Provider Demographics
NPI:1982149431
Name:MOELLER, CAITLIN BRIANA (MSC, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:BRIANA
Last Name:MOELLER
Suffix:
Gender:F
Credentials:MSC, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 W CAMPUS DR
Mailing Address - Street 2:CAMPUS BOX 126
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-3639
Mailing Address - Country:US
Mailing Address - Phone:478-445-8672
Mailing Address - Fax:
Practice Address - Street 1:134 W CAMPUS DR
Practice Address - Street 2:CAMPUS BOX 126
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-3639
Practice Address - Country:US
Practice Address - Phone:478-445-8672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0030572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer