Healthcare Provider Details

I. General information

NPI: 1932093135
Provider Name (Legal Business Name): CAITLIN ANNE PETERS CP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 OLD GROVE RD
GREENVILLE SC
29605-4769
US

IV. Provider business mailing address

703 N FANT ST STE A
ANDERSON SC
29621-5705
US

V. Phone/Fax

Practice location:
  • Phone: 864-552-9772
  • Fax:
Mailing address:
  • Phone: 864-622-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCP004629
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: