Provider Demographics
NPI:1306157516
Name:ISBISTER, CAITLIN A (LICAC, MSTOM)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:A
Last Name:ISBISTER
Suffix:
Gender:F
Credentials:LICAC, MSTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-2731
Mailing Address - Country:US
Mailing Address - Phone:518-669-1233
Mailing Address - Fax:
Practice Address - Street 1:94 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-6535
Practice Address - Country:US
Practice Address - Phone:518-669-1233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238381171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist