Provider Demographics
NPI:1811266455
Name:MCLAUGHLIN, LISA ANN (COTA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
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:HC 61 BOX 149A
Mailing Address - Street 2:
Mailing Address - City:CASS
Mailing Address - State:WV
Mailing Address - Zip Code:24927-9625
Mailing Address - Country:US
Mailing Address - Phone:304-799-4816
Mailing Address - Fax:
Practice Address - Street 1:HC 61 BOX 149A
Practice Address - Street 2:
Practice Address - City:CASS
Practice Address - State:WV
Practice Address - Zip Code:24927-9625
Practice Address - Country:US
Practice Address - Phone:304-799-4816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000957224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant