Provider Demographics
NPI:1730567918
Name:MCCAFFERTY, MARY (OTR)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MCCAFFERTY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 MAIN ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1864
Mailing Address - Country:US
Mailing Address - Phone:303-604-6441
Mailing Address - Fax:303-957-1955
Practice Address - Street 1:801 MAIN ST
Practice Address - Street 2:SUITE 10
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1864
Practice Address - Country:US
Practice Address - Phone:303-604-6441
Practice Address - Fax:303-957-1955
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO766225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics