Provider Demographics
NPI:1164287983
Name:MCCABE, LORETTA (LPTA/COTA)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:MCCABE
Suffix:
Gender:F
Credentials:LPTA/COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5867 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:TWIN LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49457-9749
Mailing Address - Country:US
Mailing Address - Phone:123-173-0052
Mailing Address - Fax:
Practice Address - Street 1:4554 W 48TH ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-8721
Practice Address - Country:US
Practice Address - Phone:231-924-3990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202007059225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant