Provider Demographics
NPI:1457544124
Name:MCLAUGHLIN, KATRINA LYN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:LYN
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 WEST MAIN ST.
Mailing Address - Street 2:SUITE12
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-1907
Mailing Address - Country:US
Mailing Address - Phone:719-846-4178
Mailing Address - Fax:
Practice Address - Street 1:324 WEST MAIN ST.
Practice Address - Street 2:SUITE12
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-1907
Practice Address - Country:US
Practice Address - Phone:719-846-4178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT652174400000X
COMT.0013782225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist