Provider Demographics
NPI:1285653634
Name:MCKEE, JONATHAN (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:MCKEE
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 491621
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30049-0028
Mailing Address - Country:US
Mailing Address - Phone:770-778-1239
Mailing Address - Fax:770-945-1356
Practice Address - Street 1:1740 RIDGEMILL TER
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-2949
Practice Address - Country:US
Practice Address - Phone:770-778-1239
Practice Address - Fax:770-945-1356
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT002786225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00814283CMedicaid