Provider Demographics
NPI:1972915171
Name:BUSSARD, CAITLYN (ATC, LAT)
Entity type:Individual
Prefix:MRS
First Name:CAITLYN
Middle Name:
Last Name:BUSSARD
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15729 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-1188
Mailing Address - Country:US
Mailing Address - Phone:412-956-1317
Mailing Address - Fax:
Practice Address - Street 1:1580 BUCHANAN TRL E
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:PA
Practice Address - Zip Code:17225-9511
Practice Address - Country:US
Practice Address - Phone:717-643-0574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0052532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer