Provider Demographics
NPI:1922733807
Name:WHITCHURCH, MCKENSEY MARIE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:MCKENSEY
Middle Name:MARIE
Last Name:WHITCHURCH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 HOFF RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MO
Mailing Address - Zip Code:63366-1936
Mailing Address - Country:US
Mailing Address - Phone:163-629-3573
Mailing Address - Fax:
Practice Address - Street 1:2275 SOMMERS RD
Practice Address - Street 2:
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-6406
Practice Address - Country:US
Practice Address - Phone:636-561-0075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-23
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020035410224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant