Provider Demographics
NPI:1801084264
Name:MCKINNEY, JULIE ANN (OTR)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 N STATE LINE AVE
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-5309
Mailing Address - Country:US
Mailing Address - Phone:903-791-2270
Mailing Address - Fax:903-792-0816
Practice Address - Street 1:6101 N STATE LINE AVE
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-5309
Practice Address - Country:US
Practice Address - Phone:903-791-2270
Practice Address - Fax:903-792-0816
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109123225X00000X
AROTR1571225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist