Provider Demographics
NPI:1417310269
Name:MCDEVITT, CHARITY (PTA)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:
Last Name:MCDEVITT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 S MATTESON ST
Mailing Address - Street 2:
Mailing Address - City:MAQUOKETA
Mailing Address - State:IA
Mailing Address - Zip Code:52060-3119
Mailing Address - Country:US
Mailing Address - Phone:563-357-1060
Mailing Address - Fax:
Practice Address - Street 1:219 S MATTESON ST
Practice Address - Street 2:
Practice Address - City:MAQUOKETA
Practice Address - State:IA
Practice Address - Zip Code:52060-3119
Practice Address - Country:US
Practice Address - Phone:563-357-1060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0001417314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility