Provider Demographics
NPI:1487484762
Name:CALDWELL THOMAS, CELINE (COTA/L)
Entity type:Individual
Prefix:
First Name:CELINE
Middle Name:
Last Name:CALDWELL THOMAS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14251 E PLACITA CORONA DEL SOL
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-6524
Mailing Address - Country:US
Mailing Address - Phone:801-787-8853
Mailing Address - Fax:
Practice Address - Street 1:12775 E MARY ANN CLEVELAND WAY
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:AZ
Practice Address - Zip Code:85641-8600
Practice Address - Country:US
Practice Address - Phone:520-879-1753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTA-050009224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant