Provider Demographics
NPI:1811199805
Name:MCKINNEY, SHIRLEY JEAN (OTD, OTR)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:JEAN
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 W RD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68826-8029
Mailing Address - Country:US
Mailing Address - Phone:402-672-4518
Mailing Address - Fax:
Practice Address - Street 1:1505 W RD
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:NE
Practice Address - Zip Code:68826-8029
Practice Address - Country:US
Practice Address - Phone:402-672-4518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE905225X00000X
IA01643225X00000X
TX111664225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist