Healthcare Provider Details

I. General information

NPI: 1306516224
Provider Name (Legal Business Name): CAITLYN CAUBBLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 SOUTHWEST DR
JONESBORO AR
72401-5828
US

IV. Provider business mailing address

4027 GABRIEL CT
JONESBORO AR
72405-8676
US

V. Phone/Fax

Practice location:
  • Phone: 870-932-0090
  • Fax: 870-930-9336
Mailing address:
  • Phone: 870-919-2464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: