Provider Demographics
NPI:1275399800
Name:MCKAY, LAURA ELLEN (OTD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ELLEN
Last Name:MCKAY
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6485 N RURAL ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2266
Mailing Address - Country:US
Mailing Address - Phone:317-529-0719
Mailing Address - Fax:
Practice Address - Street 1:12950 TALBLICK ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-6347
Practice Address - Country:US
Practice Address - Phone:317-773-3854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31007426A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist