Provider Demographics
NPI:1932784634
Name:MCKISSICK, BRITTNEY LEANNE (OTR)
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:LEANNE
Last Name:MCKISSICK
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 1:5616 DOGWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:EIGHT MILE
Mailing Address - State:AL
Mailing Address - Zip Code:36613-8510
Mailing Address - Country:US
Mailing Address - Phone:251-721-1907
Mailing Address - Fax:
Practice Address - Street 1:300 FAULKNER DR
Practice Address - Street 2:
Practice Address - City:BAY MINETTE
Practice Address - State:AL
Practice Address - Zip Code:36507-2771
Practice Address - Country:US
Practice Address - Phone:251-937-9881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-14
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4960225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist