Provider Demographics
NPI:1144718685
Name:MCELYEA, KATHLEEN KEGLOVITS (OT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:KEGLOVITS
Last Name:MCELYEA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 ELMHURST DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3258
Mailing Address - Country:US
Mailing Address - Phone:214-535-4658
Mailing Address - Fax:
Practice Address - Street 1:6401 OHIO DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-6700
Practice Address - Country:US
Practice Address - Phone:214-535-4658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
114041225X00000X
TX114041225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist