Provider Demographics
NPI:1336635150
Name:MCNAMARA, MCKAYLA
Entity Type:Individual
Prefix:
First Name:MCKAYLA
Middle Name:
Last Name:MCNAMARA
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 1:10980 CAYUSE CT APT 1
Mailing Address - Street 2:
Mailing Address - City:LOLO
Mailing Address - State:MT
Mailing Address - Zip Code:59847-8543
Mailing Address - Country:US
Mailing Address - Phone:406-370-3335
Mailing Address - Fax:
Practice Address - Street 1:10980 CAYUSE CT APT 1
Practice Address - Street 2:
Practice Address - City:LOLO
Practice Address - State:MT
Practice Address - Zip Code:59847-8543
Practice Address - Country:US
Practice Address - Phone:406-370-3335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-04
Last Update Date:2018-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer