Healthcare Provider Details

I. General information

NPI: 1437638749
Provider Name (Legal Business Name): KRISTIN TABATHA CAULDWELL , NCLMBT, MMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMPASS POINT WELLNESS CENTER 2308 E OAKBRIDGE WAY NE
LELAND NC
28451-0230
US

IV. Provider business mailing address

8209 IBIS PT NE
LELAND NC
28451-8805
US

V. Phone/Fax

Practice location:
  • Phone: 919-414-7909
  • Fax:
Mailing address:
  • Phone: 919-414-7909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number12165
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number12165
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: