Provider Demographics
NPI:1609377910
Name:SMITH, CAITLIN A (OT)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:A
Other - Last Name:O'TOOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:414-858-1740
Mailing Address - Fax:414-858-1741
Practice Address - Street 1:9120 W LOOMIS RD STE 100
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9083
Practice Address - Country:US
Practice Address - Phone:414-858-1740
Practice Address - Fax:414-858-1741
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6179-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100077222Medicaid