Provider Demographics
NPI:1336851310
Name:ADDISON-MCQUITTY, MARY-CATHERINE KELLAM (OTR, OTD)
Entity Type:Individual
Prefix:
First Name:MARY-CATHERINE
Middle Name:KELLAM
Last Name:ADDISON-MCQUITTY
Suffix:
Gender:F
Credentials:OTR, OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 KEN DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-2106
Mailing Address - Country:US
Mailing Address - Phone:757-373-4197
Mailing Address - Fax:
Practice Address - Street 1:5302 JANELLE DR
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-5666
Practice Address - Country:US
Practice Address - Phone:254-699-3933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123433225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist