Provider Demographics
NPI:1447535935
Name:MCCRACKEN, KATHLEEN L (COTA/L)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:L
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 BURNHAM RD
Mailing Address - Street 2:
Mailing Address - City:FREEDOM
Mailing Address - State:NH
Mailing Address - Zip Code:03836-4805
Mailing Address - Country:US
Mailing Address - Phone:757-869-8661
Mailing Address - Fax:
Practice Address - Street 1:200 BRICKSTONE SQUARE, 3RD FLOOR
Practice Address - Street 2:GENESIS REHAB SERVICES
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810
Practice Address - Country:US
Practice Address - Phone:800-804-4494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0603224Z00000X
VA0131000388224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant