Provider Demographics
NPI:1235771056
Name:MCKINNEY, KATHLEEN REBECCA (MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:REBECCA
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:REBECCS
Other - Last Name:SANFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT-BC
Mailing Address - Street 1:196 QUEEN ST.
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:196 QUEEN ST.
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489
Practice Address - Country:US
Practice Address - Phone:860-518-5557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist