Provider Demographics
NPI:1891433710
Name:BRAZIL, CAITLYN J (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:J
Last Name:BRAZIL
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N JONESBORO AVE APT B
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-3538
Mailing Address - Country:US
Mailing Address - Phone:479-970-9055
Mailing Address - Fax:
Practice Address - Street 1:210 N JONESBORO AVE APT B
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-3538
Practice Address - Country:US
Practice Address - Phone:479-970-9055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-20
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARRBT-22-215218106S00000X
AR225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician