Provider Demographics
NPI:1205679826
Name:MCGINNIS, AYLA MAREE (PSS)
Entity type:Individual
Prefix:
First Name:AYLA
Middle Name:MAREE
Last Name:MCGINNIS
Suffix:
Gender:F
Credentials:PSS
Other - Prefix:
Other - First Name:AYLA
Other - Middle Name:MAREE
Other - Last Name:HARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:422 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-6048
Mailing Address - Country:US
Mailing Address - Phone:541-539-0377
Mailing Address - Fax:
Practice Address - Street 1:422 MAIN ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6048
Practice Address - Country:US
Practice Address - Phone:541-539-0377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR111425175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist