Provider Demographics
NPI:1376060863
Name:MCKINNEY, KELSEY (MS, OTR)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 PROVIDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-4520
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:803 S HAMILTON ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:IN
Practice Address - Zip Code:46069-1415
Practice Address - Country:US
Practice Address - Phone:317-758-4426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31006413A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist