Provider Demographics
NPI:1770330763
Name:MCCLURE, KATELYN LENAE (DPT)
Entity type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:LENAE
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1880 N PERRY ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:OH
Mailing Address - Zip Code:45875-1164
Mailing Address - Country:US
Mailing Address - Phone:419-523-9003
Mailing Address - Fax:419-523-9143
Practice Address - Street 1:1880 N PERRY ST STE 100
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:OH
Practice Address - Zip Code:45875-1164
Practice Address - Country:US
Practice Address - Phone:419-523-9003
Practice Address - Fax:419-523-9143
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT021046225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist