Provider Demographics
NPI:1306242896
Name:MACKINLAY, JEAN MARIE (COTA/L)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:MACKINLAY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 WHITNEY LN
Mailing Address - Street 2:
Mailing Address - City:MAPLE GLEN
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2933
Mailing Address - Country:US
Mailing Address - Phone:215-283-2984
Mailing Address - Fax:
Practice Address - Street 1:915 WHITNEY LN
Practice Address - Street 2:
Practice Address - City:MAPLE GLEN
Practice Address - State:PA
Practice Address - Zip Code:19002-2933
Practice Address - Country:US
Practice Address - Phone:215-283-2984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP00823224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant