MEDICARE: CAITLIN ALLEN

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	225X00000X	Occupational Therapist	20079	CA

General Provider Information

NPI Number	:	1871153510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLIN ALLEN

Provider Business Mailing Address
First Line	:	1360 1/2 ALLISON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-6428
Country	:	US
Telephone Number	:	617-721-0280
Fax Number	:

Provider Business Practice Location Address
First Line	:	1360 1/2 ALLISON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-6428
Country	:	US
Telephone Number	:	617-721-0280
Fax Number	:

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

Provider Enumeration Date	:	06/14/2019
Last Update Date	:	06/14/2019

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Directions to “ CAITLIN ALLEN ” Practice Location

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