Provider Demographics
NPI:1225225840
Name:MAGINN, KATHLEEN TERESE (OT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:TERESE
Last Name:MAGINN
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:PO BOX 7014
Mailing Address - Street 2:
Mailing Address - City:PORSTMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-7014
Mailing Address - Country:US
Mailing Address - Phone:757-377-3968
Mailing Address - Fax:
Practice Address - Street 1:3300 HIGH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3321
Practice Address - Country:US
Practice Address - Phone:757-673-5689
Practice Address - Fax:757-673-5678
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2020-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004251225X00000X
222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00450670OtherMEDICARE RR
VA015911O04Medicare PIN