Provider Demographics
NPI:1649073552
Name:WICHNOSKI, CAITLIN DENISE (OT R/L)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:DENISE
Last Name:WICHNOSKI
Suffix:
Gender:
Credentials:OT R/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 WELL SPRING DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-8857
Mailing Address - Country:US
Mailing Address - Phone:336-545-5400
Mailing Address - Fax:
Practice Address - Street 1:4100 WELL SPRING DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-8857
Practice Address - Country:US
Practice Address - Phone:336-545-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17530225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist