Provider Demographics
NPI:1679674592
Name:MCCAIGUE, IIEANA SEOANE (OTR/L, CDRS)
Entity Type:Individual
Prefix:MS
First Name:IIEANA
Middle Name:SEOANE
Last Name:MCCAIGUE
Suffix:
Gender:F
Credentials:OTR/L, CDRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 1658
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2785
Mailing Address - Country:US
Mailing Address - Phone:404-422-2931
Mailing Address - Fax:770-338-0107
Practice Address - Street 1:2582 COLLINS PORT CV
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2785
Practice Address - Country:US
Practice Address - Phone:404-422-2931
Practice Address - Fax:770-338-0107
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000131225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA800193862OtherEMPLOYER IDENTIFICATION NUMBER