Provider Demographics
NPI:1912128893
Name:MCCAFFERTY, LETITIA ANN (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:LETITIA
Middle Name:ANN
Last Name:MCCAFFERTY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W JEFFERSON ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-3694
Mailing Address - Country:US
Mailing Address - Phone:217-726-8502
Mailing Address - Fax:217-726-8568
Practice Address - Street 1:1200 W JEFFERSON ST
Practice Address - Street 2:SUITE D
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-3694
Practice Address - Country:US
Practice Address - Phone:217-726-8502
Practice Address - Fax:217-726-8568
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL56002252225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist