Healthcare Provider Details

I. General information

NPI: 1124757034
Provider Name (Legal Business Name): CECIBEL KARINA MCLAIN A.S., LPTA, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 01/18/2026
Certification Date: 01/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 E 90TH DR STE W2
MERRILLVILLE IN
46410-8145
US

IV. Provider business mailing address

57 S 400 E
VALPARAISO IN
46383-9521
US

V. Phone/Fax

Practice location:
  • Phone: 219-215-4098
  • Fax:
Mailing address:
  • Phone: 219-928-6740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06005993A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT21104001
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: