Provider Demographics
NPI:1508998030
Name:MCCLAIN, KATHY CASH (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:CASH
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 CASH BLACKMON RD
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71049-3249
Mailing Address - Country:US
Mailing Address - Phone:318-458-2548
Mailing Address - Fax:
Practice Address - Street 1:107 WOODBINE PL
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-2912
Practice Address - Country:US
Practice Address - Phone:318-697-2479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111952225XP0200X
LAZ10189225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1302244Medicaid