Provider Demographics
NPI:1154299691
Name:MCCARTY, KATHLEEN (OTA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 WYNDGATE TRAIL CT
Mailing Address - Street 2:
Mailing Address - City:LAKE SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-4388
Mailing Address - Country:US
Mailing Address - Phone:314-606-2338
Mailing Address - Fax:
Practice Address - Street 1:67 WYNDGATE TRAIL CT
Practice Address - Street 2:
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-4388
Practice Address - Country:US
Practice Address - Phone:314-606-2338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-27
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006022466224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant