Provider Demographics
NPI:1497128359
Name:MCKINLEY, RACHEL MILDRED (OT)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:MILDRED
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5036 ACORN DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WI
Mailing Address - Zip Code:53563-8401
Mailing Address - Country:US
Mailing Address - Phone:608-289-8261
Mailing Address - Fax:
Practice Address - Street 1:5036 ACORN DR
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WI
Practice Address - Zip Code:53563
Practice Address - Country:US
Practice Address - Phone:082-898-2616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-01
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2875-26225X00000X
IL056.003533225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist