Healthcare Provider Details

I. General information

NPI: 1003740093
Provider Name (Legal Business Name): CAITLIN LANE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 S 29TH ST
LINCOLN NE
68516-5802
US

IV. Provider business mailing address

PO BOX 736707
CHICAGO IL
60673-6707
US

V. Phone/Fax

Practice location:
  • Phone: 317-502-3512
  • Fax: 855-915-0244
Mailing address:
  • Phone: 317-502-3512
  • Fax: 855-915-0244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-506694
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: