Provider Demographics
NPI:1932655230
Name:MCKINNEY, LENA (COTA)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:
Last Name:MCKINNEY
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 1:424 WALKER PLACE
Mailing Address - Street 2:2216 N RILEY HWY
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176
Mailing Address - Country:US
Mailing Address - Phone:317-398-1335
Mailing Address - Fax:317-398-1345
Practice Address - Street 1:2216 N RILEY HWY
Practice Address - Street 2:WALKER PLACE 424
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-9311
Practice Address - Country:US
Practice Address - Phone:317-398-1335
Practice Address - Fax:317-398-1345
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32003012A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist