Provider Demographics
NPI:1629024351
Name:MCKINLEY, SANDRA LEE (OTR)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LEE
Other - Last Name:ROWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:425 FERRET RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-4036
Mailing Address - Country:US
Mailing Address - Phone:865-671-8499
Mailing Address - Fax:
Practice Address - Street 1:4512 CHAPMAN HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-4359
Practice Address - Country:US
Practice Address - Phone:865-577-7779
Practice Address - Fax:865-577-7279
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3656675Medicaid
TN4110402OtherBCBST
TN3656675Medicaid