Provider Demographics
NPI:1063921278
Name:SMITH, CAITLYN O'NEIL (PT, DPT)
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:O'NEIL
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CAITLYN
Other - Middle Name:O'NEIL
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2861 S UTICA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80236-2104
Mailing Address - Country:US
Mailing Address - Phone:517-442-5669
Mailing Address - Fax:
Practice Address - Street 1:4765 JACKSON RD STE B
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-1847
Practice Address - Country:US
Practice Address - Phone:734-926-4710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0015179225100000X
MI5501018385225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPTL.0015179OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES DIVISION OF PROFESSIONS AND OCCUPATIO
MI5501018385OtherMICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS BOARD OF PHYSICAL THERAP