Provider Demographics
NPI:1386325579
Name:VANCE, CAITLIN (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:VANCE
Suffix:
Gender:
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 1:14545 W INDIAN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-9243
Mailing Address - Country:US
Mailing Address - Phone:623-242-6908
Mailing Address - Fax:
Practice Address - Street 1:14545 W INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-9243
Practice Address - Country:US
Practice Address - Phone:623-242-6908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16113225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist