Provider Demographics
NPI:1497092431
Name:MCDERMOTT, KATHY ANN (PTA)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:ANN
Last Name:MCDERMOTT
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 1:307 N HODGES RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99016-9623
Mailing Address - Country:US
Mailing Address - Phone:509-720-6205
Mailing Address - Fax:
Practice Address - Street 1:2219 N 6TH ST
Practice Address - Street 2:
Practice Address - City:CHENEY
Practice Address - State:WA
Practice Address - Zip Code:99004-2171
Practice Address - Country:US
Practice Address - Phone:150-923-5619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant