Provider Demographics
NPI:1033315890
Name:MCCABE, KATHLEEN ELIZABETH
Entity Type:Individual
Prefix:MISS
First Name:KATHLEEN
Middle Name:ELIZABETH
Last Name:MCCABE
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:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:GULF HAMMOCK
Mailing Address - State:FL
Mailing Address - Zip Code:32639-0245
Mailing Address - Country:US
Mailing Address - Phone:352-486-6064
Mailing Address - Fax:
Practice Address - Street 1:124 SE 1ST ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:FL
Practice Address - Zip Code:32696-2602
Practice Address - Country:US
Practice Address - Phone:352-486-6064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA20357225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist