Provider Demographics
NPI:1437574308
Name:CARROLL, MCKINNON JEAN (MS OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MCKINNON
Middle Name:JEAN
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8400 OSUNA RD NE
Mailing Address - Street 2:SUITE 3-C
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111
Mailing Address - Country:US
Mailing Address - Phone:505-248-1586
Mailing Address - Fax:505-248-1722
Practice Address - Street 1:8400 OSUNA RD NE
Practice Address - Street 2:SUITE 3-C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111
Practice Address - Country:US
Practice Address - Phone:505-248-1586
Practice Address - Fax:505-248-1722
Is Sole Proprietor?:No
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2729225X00000X
225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation