Provider Demographics
NPI:1093254781
Name:MCKINNEY, CHELSI (COTA/L)
Entity Type:Individual
Prefix:
First Name:CHELSI
Middle Name:
Last Name:MCKINNEY
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 1:467 MOUNT WILLIE RD
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:AR
Mailing Address - Zip Code:71749-9030
Mailing Address - Country:US
Mailing Address - Phone:870-918-1486
Mailing Address - Fax:
Practice Address - Street 1:467 MOUNT WILLIE RD
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:AR
Practice Address - Zip Code:71749-9030
Practice Address - Country:US
Practice Address - Phone:870-918-1486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1171224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant