Provider Demographics
NPI:1316100357
Name:MCNUTT, RINA DAWN (COTA/L)
Entity type:Individual
Prefix:
First Name:RINA
Middle Name:DAWN
Last Name:MCNUTT
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:PO BOX 167
Mailing Address - Street 2:
Mailing Address - City:MAXIE
Mailing Address - State:VA
Mailing Address - Zip Code:24628-0167
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:60 PHILLIPS BRANCH RD
Practice Address - Street 2:
Practice Address - City:PHELPS
Practice Address - State:KY
Practice Address - Zip Code:41553-9061
Practice Address - Country:US
Practice Address - Phone:606-456-8725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA3501224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant