Provider Demographics
NPI:1528734290
Name:JEFFRIES, CAITLYN ANGELIQUE (OTR/L)
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:ANGELIQUE
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CAITLYN
Other - Middle Name:ANGELIQUE
Other - Last Name:TERHUNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3170 CHELTENHAM CT
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-8508
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5375 WILLIAM FLYNN HWY STE 8
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-9628
Practice Address - Country:US
Practice Address - Phone:724-444-5333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-21
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6805225XP0200X
PAOC019804225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics