Provider Demographics
NPI:1902011133
Name:MCGUIRE, KATHLEEN R (PTA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:R
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 CRABAPPLE LN
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-9781
Mailing Address - Country:US
Mailing Address - Phone:219-548-9288
Mailing Address - Fax:219-548-9288
Practice Address - Street 1:911 CRABAPPLE LN
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-9781
Practice Address - Country:US
Practice Address - Phone:219-548-9288
Practice Address - Fax:219-548-9288
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002724A247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other