Provider Demographics
NPI:1851732218
Name:MCKINNEY, KIM (OT/PT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:OT/PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S TREE GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5234
Mailing Address - Country:US
Mailing Address - Phone:904-669-4285
Mailing Address - Fax:
Practice Address - Street 1:601 S TREE GARDEN DR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5234
Practice Address - Country:US
Practice Address - Phone:904-669-4285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 204372251P0200X
FLOT 9943225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics