Healthcare Provider Details

I. General information

NPI: 1588073589
Provider Name (Legal Business Name): CAITLIN CHABUT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2014
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7677 YANKEE ST STE 140
DAYTON OH
45459-3475
US

IV. Provider business mailing address

7677 YANKEE ST STE 140
DAYTON OH
45459-3475
US

V. Phone/Fax

Practice location:
  • Phone: 937-454-9527
  • Fax: 937-454-9532
Mailing address:
  • Phone: 937-454-9527
  • Fax: 937-454-9532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.004070
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: