Provider Demographics
NPI:1598890931
Name:MCKEOWN, CATHERINE LUCILLE (OTRL)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:LUCILLE
Last Name:MCKEOWN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 HALLOCK RD
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-3027
Mailing Address - Country:US
Mailing Address - Phone:631-689-5978
Mailing Address - Fax:
Practice Address - Street 1:264 HALLOCK RD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-3027
Practice Address - Country:US
Practice Address - Phone:631-689-5978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012018225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics