Healthcare Provider Details

I. General information

NPI: 1790092401
Provider Name (Legal Business Name): CAITLIN RAE WHITAKER MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 TIMBER CREST CT
POOLER GA
31322-3953
US

IV. Provider business mailing address

35 TIMBER CREST CT
POOLER GA
31322-3953
US

V. Phone/Fax

Practice location:
  • Phone: 912-293-1161
  • Fax:
Mailing address:
  • Phone: 912-293-1161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: