Provider Demographics
NPI:1760655047
Name:MCKAY, CONNIE KATHLEEN
Entity Type:Individual
Prefix:MISS
First Name:CONNIE
Middle Name:KATHLEEN
Last Name:MCKAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16176 W WOODLAND HILLS DR
Mailing Address - Street 2:UNIT 1
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-6529
Mailing Address - Country:US
Mailing Address - Phone:715-663-0368
Mailing Address - Fax:
Practice Address - Street 1:16176 W WOODLAND HILLS DR
Practice Address - Street 2:UNIT 1
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-6529
Practice Address - Country:US
Practice Address - Phone:715-663-0368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1961-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant