MEDICARE: KAITLYN CASPERO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	OC013839	PA

General Provider Information

NPI Number	:	1194119065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN CASPERO

Provider Business Mailing Address
First Line	:	718 ROCKWOOD AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15234-1211
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1405 SHADY AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15217
Country	:	US
Telephone Number	:	412-420-2226
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2015
Last Update Date	:	01/24/2019

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