MEDICARE: MS. CAITLIN ELISABETH LEFEVRE MS, ATC, OTC

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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	2000009463	OH

General Provider Information

NPI Number	:	1952817413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAITLIN ELISABETH LEFEVRE MS, ATC, OTC

Provider Business Mailing Address
First Line	:	8109 SILVERSTONE DR
Second Line	:
City	:	WATERVILLE
State	:	OH
Zip	:	43566-9436
Country	:	US
Telephone Number	:	419-377-8541
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 REGENCY CT STE 212
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-3091
Country	:	US
Telephone Number	:	567-661-0328
Fax Number	:	419-720-0022

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

Provider Enumeration Date	:	12/20/2017
Last Update Date	:	12/20/2017

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