Provider Demographics
NPI:1386041671
Name:MCGINN, KATHRYN LOUISE (ATC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LOUISE
Last Name:MCGINN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5722 ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:NEW PLYMOUTH
Mailing Address - State:ID
Mailing Address - Zip Code:83655-5103
Mailing Address - Country:US
Mailing Address - Phone:208-270-0431
Mailing Address - Fax:
Practice Address - Street 1:721 W 12TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-3827
Practice Address - Country:US
Practice Address - Phone:208-365-0985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAT-499174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist