MEDICARE: TREVOR CAETTA QMHS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator		OH

General Provider Information

NPI Number	:	1306777370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TREVOR CAETTA QMHS

Provider Business Mailing Address
First Line	:	1737 GEORGETOWN RD STE H
Second Line	:
City	:	HUDSON
State	:	OH
Zip	:	44236-5013
Country	:	US
Telephone Number	:	330-355-9729
Fax Number	:

Provider Business Practice Location Address
First Line	:	1737 GEORGETOWN RD STE H
Second Line	:
City	:	HUDSON
State	:	OH
Zip	:	44236-5013
Country	:	US
Telephone Number	:	330-355-9729
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/27/2026

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