Provider Demographics
NPI:1528325719
Name:MACLUER, KATHLEEN S (PA, OT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:S
Last Name:MACLUER
Suffix:
Gender:F
Credentials:PA, OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1839 S ALMA SCHOOL RD STE 354
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3028
Mailing Address - Country:US
Mailing Address - Phone:480-726-2287
Mailing Address - Fax:
Practice Address - Street 1:2 N CENTRAL AVE STE 120
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-2972
Practice Address - Country:US
Practice Address - Phone:602-296-4060
Practice Address - Fax:602-296-4146
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6797225X00000X
AZ7209350001332B00000X
AZ7057360001332B00000X
AZ7045160001332B00000X
AZ7046960001332B00000X
AZ7041750001332B00000X
AZ7629170001332B00000X
AZ7034950001332B00000X
AZ6727363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies