Provider Demographics
NPI:1700433935
Name:MCMILLIAN, KATY (COTA/L)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:
Last Name:MCMILLIAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 NEFF RD
Mailing Address - Street 2:
Mailing Address - City:LEASBURG
Mailing Address - State:MO
Mailing Address - Zip Code:65535-8181
Mailing Address - Country:US
Mailing Address - Phone:573-205-6775
Mailing Address - Fax:
Practice Address - Street 1:1000 E LIONS CLUB DR
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-4356
Practice Address - Country:US
Practice Address - Phone:573-206-6775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019005375224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant