Healthcare Provider Details

I. General information

NPI: 1508274994
Provider Name (Legal Business Name): CAITLIN ZITA MOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 S 2ND AVE
WALLA WALLA WA
99362-4116
US

IV. Provider business mailing address

1025 S 2ND AVE
WALLA WALLA WA
99362-4116
US

V. Phone/Fax

Practice location:
  • Phone: 95-897-2100
  • Fax: 509-897-5752
Mailing address:
  • Phone: 95-897-2100
  • Fax: 509-897-5752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1361
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT60768189
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: