Provider Demographics
NPI:1861250367
Name:MARTIN, CAITLYN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:CAITLYN
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:118 ADRIS PL
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-1997
Mailing Address - Country:US
Mailing Address - Phone:334-677-6360
Mailing Address - Fax:334-678-6540
Practice Address - Street 1:1032 BOLL WEEVIL CIR STE F-G
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-1381
Practice Address - Country:US
Practice Address - Phone:334-475-2006
Practice Address - Fax:334-475-2021
Is Sole Proprietor?:No
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist