Provider Demographics
NPI:1902294903
Name:MCELVAINE, CAITLIN (ATC)
Entity Type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:
Last Name:MCELVAINE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MS
Other - First Name:CAITLIN
Other - Middle Name:STEWART
Other - Last Name:NIELSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:112 W DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-1601
Mailing Address - Country:US
Mailing Address - Phone:609-610-1836
Mailing Address - Fax:
Practice Address - Street 1:112 W DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-1601
Practice Address - Country:US
Practice Address - Phone:609-610-1836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT002035002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer