Healthcare Provider Details

I. General information

NPI: 1619370236
Provider Name (Legal Business Name): CAITLIN STOLTMAN CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2014
Last Update Date: 09/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1669 W. MAPLE RD. FAR
BIRMINGHAM MI
48009
US

IV. Provider business mailing address

1669 W. MAPLE RD. FAR
BIRMINGHAM MI
48009
US

V. Phone/Fax

Practice location:
  • Phone: 248-646-3347
  • Fax:
Mailing address:
  • Phone: 248-646-3347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: