Provider Demographics
NPI:1356639231
Name:HUTCHISON, KATELYN MCCORMICK (PT)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:MCCORMICK
Last Name:HUTCHISON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:HILL
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:375TH MEDICAL GROUP
Mailing Address - Street 2:310 WEST LOSEY STREET
Mailing Address - City:SCOTT AFB
Mailing Address - State:IL
Mailing Address - Zip Code:62225
Mailing Address - Country:US
Mailing Address - Phone:616-256-6280
Mailing Address - Fax:
Practice Address - Street 1:375TH MEDICAL GROUP
Practice Address - Street 2:310 WEST LOSEY STREET
Practice Address - City:SCOTT AFB
Practice Address - State:IL
Practice Address - Zip Code:62225
Practice Address - Country:US
Practice Address - Phone:616-256-6280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011020346225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO13806876OtherCAQH
MO147410025Medicare PIN