MEDICARE: CAITLIN ROSE GANSERT OTR

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	222Q00000X	Developmental Therapist
2	225X00000X	Occupational Therapist	OT01933	RI

General Provider Information

NPI Number	:	1770075038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLIN ROSE GANSERT OTR

Provider Business Mailing Address
First Line	:	1 RANDALL SQ STE 302
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02904-2773
Country	:	US
Telephone Number	:	401-443-5202
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 RANDALL SQ STE 302
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02904-2773
Country	:	US
Telephone Number	:	401-443-5252
Fax Number	:

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

Provider Enumeration Date	:	06/03/2018
Last Update Date	:	11/27/2023

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Directions to “ CAITLIN ROSE GANSERT OTR” Practice Location

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