Provider Demographics
NPI:1669649760
Name:MCAGHON, KATE (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:KATE
Middle Name:
Last Name:MCAGHON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 N PALMER ST APT 3
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-3259
Mailing Address - Country:US
Mailing Address - Phone:240-475-3103
Mailing Address - Fax:
Practice Address - Street 1:2022 N PALMER ST APT 3
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-3259
Practice Address - Country:US
Practice Address - Phone:240-475-3103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4544-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist