Provider Demographics
NPI:1114297686
Name:MCKINSEY, JEFFREY A (COTA)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:MCKINSEY
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 PENN ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-2643
Mailing Address - Country:US
Mailing Address - Phone:321-768-6800
Mailing Address - Fax:321-768-6858
Practice Address - Street 1:1800 PENN ST
Practice Address - Street 2:SUITE 12
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2643
Practice Address - Country:US
Practice Address - Phone:321-768-6800
Practice Address - Fax:321-768-6858
Is Sole Proprietor?:No
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA12083224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant