Provider Demographics
NPI:1376748764
Name:MCKINNEY, ANN MARIE (OTRL)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 MUSEUM RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-4710
Mailing Address - Country:US
Mailing Address - Phone:501-329-3804
Mailing Address - Fax:501-329-0718
Practice Address - Street 1:1500 MUSEUM RD
Practice Address - Street 2:SUITE 104
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4710
Practice Address - Country:US
Practice Address - Phone:501-329-3804
Practice Address - Fax:501-329-0718
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1867225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist