Healthcare Provider Details

I. General information

NPI: 1487462149
Provider Name (Legal Business Name): CAITLYN SKIDMORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2024
Last Update Date: 12/26/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 MADISON RD
CINCINNATI OH
45227-1491
US

IV. Provider business mailing address

505 MADISON ROAD
CINCINNATI OH
45227-1491
US

V. Phone/Fax

Practice location:
  • Phone: 513-272-2800
  • Fax: 513-272-2807
Mailing address:
  • Phone: 513-272-2800
  • Fax: 513-272-2807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number171M00000X
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: