=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376343087
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAITLYN MARIE CARPENTER OT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2025
-----------------------------------------------------
Last Update Date | 03/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6264 GROVELAND RD
-----------------------------------------------------
City | PIPERSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18947-1226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-808-7084
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6264 GROVELAND RD
-----------------------------------------------------
City | PIPERSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18947-1226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OC011501
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------