Healthcare Provider Details

I. General information

NPI: 1851935704
Provider Name (Legal Business Name): CAITLIN FLETCHER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2019
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12812 OLD GLENN HWY STE A8
EAGLE RIVER AK
99577-7003
US

IV. Provider business mailing address

12812 OLD GLENN HWY STE A8
EAGLE RIVER AK
99577-7003
US

V. Phone/Fax

Practice location:
  • Phone: 907-696-8020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number149153
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: