1205211281 NPI number — MRS. CAITLIN ELISE DOERFLEIN PTA

Table of content: MRS. CAITLIN ELISE DOERFLEIN PTA (NPI 1205211281)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205211281 NPI number — MRS. CAITLIN ELISE DOERFLEIN PTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOERFLEIN
Provider First Name:
CAITLIN
Provider Middle Name:
ELISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JONES
Provider Other First Name:
CAITLIN
Provider Other Middle Name:
ELISE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PTA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205211281
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 LEGGETT ST
Provider Second Line Business Mailing Address:
APT B7
Provider Business Mailing Address City Name:
JONESBORO
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72401-2472
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-499-0667
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 LEGGETT ST
Provider Second Line Business Practice Location Address:
APT B7
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72401-2472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-499-0667
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225200000X , with the licence number:  PTA 3976 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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