Basic Information
| Provider Information | |||||||||
| NPI: | 1285086330 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRNKOVICH | ||||||||
| FirstName: | CAITLYN | ||||||||
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| Credential: | OTD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | MAHER | ||||||||
| OtherFirstName: | CAITLYN | ||||||||
| OtherMiddleName: | ANN | ||||||||
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| OtherCredential: | OTD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3564 POWELL PT | ||||||||
| Address2: | #306 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809222836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027098539 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3625 CITADEL DR S | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809095320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195970822 | ||||||||
| FaxNumber: | 7195994606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2016 | ||||||||
| LastUpdateDate: | 07/12/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT.0004718 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.