Healthcare Provider Details

I. General information

NPI: 1992418289
Provider Name (Legal Business Name): KATELYN MARIE MCCARTHY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2023
Last Update Date: 01/02/2023
Certification Date: 01/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 MUZZEY ST
LEXINGTON MA
02421-5256
US

IV. Provider business mailing address

53 PARK ST APT 1L
ARLINGTON MA
02474-3303
US

V. Phone/Fax

Practice location:
  • Phone: 978-237-4937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number13916
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: