Healthcare Provider Details

I. General information

NPI: 1891432373
Provider Name (Legal Business Name): CAITLIN KOTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 BLUE HERON BLVD W
RIVIERA BEACH FL
33404-5003
US

IV. Provider business mailing address

14170 PACIFIC POINT PL APT 204
DELRAY BEACH FL
33484-1892
US

V. Phone/Fax

Practice location:
  • Phone: 561-841-3500
  • Fax:
Mailing address:
  • Phone: 513-240-4094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: