Provider Demographics
NPI:1336774629
Name:ROTHROCK, CAITLIN SHAY
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:SHAY
Last Name:ROTHROCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3285 CENTER ST NE
Mailing Address - Street 2:
Mailing Address - City:CRANDALL
Mailing Address - State:IN
Mailing Address - Zip Code:47114
Mailing Address - Country:US
Mailing Address - Phone:502-296-1777
Mailing Address - Fax:
Practice Address - Street 1:4603 TIMBERWALK CT
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-6746
Practice Address - Country:US
Practice Address - Phone:703-864-6695
Practice Address - Fax:888-830-3233
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant