MEDICARE: CAITLIN RENEE SUE BRENNAN

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1235753609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLIN RENEE SUE BRENNAN

Provider Business Mailing Address
First Line	:	4561 STATE ROUTE 276
Second Line	:
City	:	BATAVIA
State	:	OH
Zip	:	45103-2109
Country	:	US
Telephone Number	:	937-469-1726
Fax Number	:

Provider Business Practice Location Address
First Line	:	2626 UPPER 5 MILE RD
Second Line	:
City	:	WILLIAMSBURG
State	:	OH
Zip	:	45176-9607
Country	:	US
Telephone Number	:	513-508-1170
Fax Number	:

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

Provider Enumeration Date	:	06/02/2020
Last Update Date	:	06/02/2020

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