Provider Demographics
NPI:1578578282
Name:MCKINNELL, CAITLIN ELIZABETH (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:CAITLIN
Middle Name:ELIZABETH
Last Name:MCKINNELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 DENSLOW RD
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-3103
Mailing Address - Country:US
Mailing Address - Phone:413-526-9969
Mailing Address - Fax:413-526-9960
Practice Address - Street 1:300 BIRNIE AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1107
Practice Address - Country:US
Practice Address - Phone:413-781-1054
Practice Address - Fax:413-439-0026
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9121225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA49027OtherHARVARD PILGRIM
MA043527497OtherHNE
MA690675OtherTUFTS
MA043527497OtherCT CARE
MA103355100OtherDEPT. OF LABOR
MA35265OtherBMC
MA64-04290OtherUNITED HEALTH CARE
MA9715568Medicaid
MAOT0011OtherBC/BS OF MA
MA043527497OtherCIGNA
MA972730OtherNETWORK HELATH
MA043527497OtherGIC
MA4510980001Medicare NSC
MAPT0191Medicare PIN
MA9715568Medicaid