Healthcare Provider Details

I. General information

NPI: 1124846316
Provider Name (Legal Business Name): CAITLIN JOCHIMSEN LAT, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 SCIENCE DR
MADISON WI
53711-1074
US

IV. Provider business mailing address

812 LYNN ST
WAUNAKEE WI
53597-8000
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-8850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number3083-39
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: