Provider Demographics
NPI:1740834696
Name:MCGINNIS, KATHLEEN LEIGH
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LEIGH
Last Name:MCGINNIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6789 ELM VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-7476
Mailing Address - Country:US
Mailing Address - Phone:269-544-3230
Mailing Address - Fax:269-544-3239
Practice Address - Street 1:6789 ELM VALLEY DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-7476
Practice Address - Country:US
Practice Address - Phone:269-544-3230
Practice Address - Fax:269-544-3239
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006924225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics