Provider Demographics
NPI:1376870790
Name:LOOSE, CATHERINE M (OT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:LOOSE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:
Other - Last Name:LOOSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:962 40TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-2453
Mailing Address - Country:US
Mailing Address - Phone:309-230-8722
Mailing Address - Fax:
Practice Address - Street 1:962 40TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-2453
Practice Address - Country:US
Practice Address - Phone:309-230-8722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1575535225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist