Healthcare Provider Details

I. General information

NPI: 1871396135
Provider Name (Legal Business Name): CAOILINN EISELE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5160 VILLAGE CREEK DR STE 200
PLANO TX
75093-4423
US

IV. Provider business mailing address

12720 RIVINGTON DR APT 105
FARMERS BRANCH TX
75234-1283
US

V. Phone/Fax

Practice location:
  • Phone: 682-324-9376
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-371781
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: