Healthcare Provider Details

I. General information

NPI: 1275366528
Provider Name (Legal Business Name): CAITLIN SCHLOSSER MHA, ATC, OTC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6180 BERMUDA DR
FLEMING ISLAND FL
32003-8311
US

IV. Provider business mailing address

807 CHILDRENS WAY
JACKSONVILLE FL
32207-8426
US

V. Phone/Fax

Practice location:
  • Phone: 904-319-1465
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL3300
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: