Provider Demographics
NPI:1184006413
Name:MCHONE, MIRANDA MCKINNEY (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:MCKINNEY
Last Name:MCHONE
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 1:1100 WALL LOOP RD
Mailing Address - Street 2:
Mailing Address - City:WALNUT COVE
Mailing Address - State:NC
Mailing Address - Zip Code:27052-5803
Mailing Address - Country:US
Mailing Address - Phone:336-593-5307
Mailing Address - Fax:
Practice Address - Street 1:1100 WALL LOOP RD
Practice Address - Street 2:
Practice Address - City:WALNUT COVE
Practice Address - State:NC
Practice Address - Zip Code:27052-5803
Practice Address - Country:US
Practice Address - Phone:336-593-5307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8816224Z00000X
VA0131001291224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant