MEDICARE: CAITLYN WALKER BCABA

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	103K00000X	Behavior Analyst	0-18-8635	VA

General Provider Information

NPI Number	:	1629573910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLYN WALKER BCABA

Provider Business Mailing Address
First Line	:	508 STONEHENGE AVE
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22902-6057
Country	:	US
Telephone Number	:	804-325-0964
Fax Number	:

Provider Business Practice Location Address
First Line	:	5408 CHAMBERLAYNE RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-2407
Country	:	US
Telephone Number	:	804-325-0964
Fax Number	:

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

Provider Enumeration Date	:	03/28/2018
Last Update Date	:	03/28/2018

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Directions to “ CAITLYN WALKER BCABA” Practice Location

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