Provider Demographics
NPI:1528321635
Name:SPROUSE, CAITLIN LEE
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:LEE
Last Name:SPROUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14550 YORK RD STE A
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9307
Mailing Address - Country:US
Mailing Address - Phone:443-330-7900
Mailing Address - Fax:410-628-0836
Practice Address - Street 1:14550A YORK ROAD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:MD
Practice Address - Zip Code:21152
Practice Address - Country:US
Practice Address - Phone:443-330-7900
Practice Address - Fax:410-628-0836
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06733225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist