Provider Demographics
NPI:1265645055
Name:MCKINLEY, ANITA JEAN
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:JEAN
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 NUMBER NINE RD
Mailing Address - Street 2:
Mailing Address - City:CUTLER
Mailing Address - State:ME
Mailing Address - Zip Code:04626-3229
Mailing Address - Country:US
Mailing Address - Phone:207-259-3359
Mailing Address - Fax:
Practice Address - Street 1:9 COOPER ST
Practice Address - Street 2:
Practice Address - City:MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04654-1114
Practice Address - Country:US
Practice Address - Phone:207-255-4892
Practice Address - Fax:207-255-6457
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1453225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics