Healthcare Provider Details

I. General information

NPI: 1639806342
Provider Name (Legal Business Name): CAITLIN VICTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S MAIN ST
NASHUA NH
03060-5042
US

IV. Provider business mailing address

469 AMHERST ST APT 3F
MANCHESTER NH
03104-5184
US

V. Phone/Fax

Practice location:
  • Phone: 603-897-8612
  • Fax:
Mailing address:
  • Phone: 541-852-6338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1593
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: