Provider Demographics
NPI:1659837987
Name:MCGUIRE, KATELYNN
Entity Type:Individual
Prefix:
First Name:KATELYNN
Middle Name:
Last Name:MCGUIRE
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 1:1477 SOUTH SCHODACK ROAD
Mailing Address - Street 2:
Mailing Address - City:CASTLETON
Mailing Address - State:NY
Mailing Address - Zip Code:12033
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1477 S SCHODACK RD
Practice Address - Street 2:
Practice Address - City:CASTLETON ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12033-9644
Practice Address - Country:US
Practice Address - Phone:518-477-7103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP13231225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics