Provider Demographics
NPI:1285086330
Name:CRNKOVICH, CAITLYN (OTD)
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:
Last Name:CRNKOVICH
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:CAITLYN
Other - Middle Name:ANN
Other - Last Name:MAHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD
Mailing Address - Street 1:3564 POWELL PT
Mailing Address - Street 2:#306
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-2836
Mailing Address - Country:US
Mailing Address - Phone:402-709-8539
Mailing Address - Fax:
Practice Address - Street 1:3625 CITADEL DR S
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5320
Practice Address - Country:US
Practice Address - Phone:719-597-0822
Practice Address - Fax:719-599-4606
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0004718225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist