Healthcare Provider Details

I. General information

NPI: 1174242580
Provider Name (Legal Business Name): ERICA CATHERINE CAINE ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERICA CATHERINE WILLIAMSON ATC

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 FOWLER AVE
CLOVIS CA
93611-2062
US

IV. Provider business mailing address

3703 ARTISTRY WAY
CLOVIS CA
93619-6915
US

V. Phone/Fax

Practice location:
  • Phone: 405-501-3101
  • Fax:
Mailing address:
  • Phone: 405-501-3101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberBOC2000014995
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: