Provider Demographics
NPI:1598155814
Name:MCGOWAN, KATELYN LEE
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:LEE
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 JULBET DR
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-1449
Mailing Address - Country:US
Mailing Address - Phone:856-357-6552
Mailing Address - Fax:
Practice Address - Street 1:61 JULBET DR
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-1449
Practice Address - Country:US
Practice Address - Phone:856-357-6552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJM1262 42673 52922390200000X
NY002320221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program