Provider Demographics
NPI:1841621935
Name:MCCLEE, LORETTA
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:MCCLEE
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 1:24964 HIGHWAY 82
Mailing Address - Street 2:
Mailing Address - City:MC CARLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38943-6616
Mailing Address - Country:US
Mailing Address - Phone:404-207-6453
Mailing Address - Fax:
Practice Address - Street 1:24964 HIGHWAY 82
Practice Address - Street 2:
Practice Address - City:MC CARLEY
Practice Address - State:MS
Practice Address - Zip Code:38943-6616
Practice Address - Country:US
Practice Address - Phone:404-207-6453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-27
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18056555146D00000X
FLCL1230175174400000X, 224P00000X, 1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No174400000XOther Service ProvidersSpecialist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist