Healthcare Provider Details

I. General information

NPI: 1548796386
Provider Name (Legal Business Name): CAITLYN POWERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 BALTIMORE ANNAPOLIS BLVD STE 216-217
SEVERNA PARK MD
21146-3931
US

IV. Provider business mailing address

3182 GULF BREEZE PKWY
GULF BREEZE FL
32563-3248
US

V. Phone/Fax

Practice location:
  • Phone: 800-676-5130
  • Fax: 888-958-5753
Mailing address:
  • Phone: 800-676-5130
  • Fax: 888-958-5753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-33304
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: