MEDICARE: CAITLIN ROSE MARTIN OT

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	225X00000X	Occupational Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17-099-0219	OTHER	CO	DRIVERS LICENSE

General Provider Information

NPI Number	:	1932707833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLIN ROSE MARTIN OT

Provider Business Mailing Address
First Line	:	710 CITY PARK AVE APT B230
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-3448
Country	:	US
Telephone Number	:	316-393-4283
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 CITY PARK AVE APT B230
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-3448
Country	:	US
Telephone Number	:	316-393-4283
Fax Number	:

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

Provider Enumeration Date	:	10/13/2020
Last Update Date	:	10/13/2020

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Directions to “ CAITLIN ROSE MARTIN OT” Practice Location

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