Provider Demographics
NPI:1972119279
Name:CLEVELAND, CAITLIN (OTD)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:
Other - Last Name:WEND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3310 YORK DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-3419
Mailing Address - Country:US
Mailing Address - Phone:217-508-3052
Mailing Address - Fax:
Practice Address - Street 1:1400 W PARK ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2334
Practice Address - Country:US
Practice Address - Phone:217-337-2377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.013664225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist