Provider Demographics
NPI:1316170848
Name:MCKINNEY, THERESE (OTR/L)
Entity type:Individual
Prefix:
First Name:THERESE
Middle Name:
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:THERESE
Other - Middle Name:
Other - Last Name:WILLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:6 DARTMOUTH CT
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-9756
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:244 PAPA PLACE
Practice Address - Street 2:102
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732
Practice Address - Country:UM
Practice Address - Phone:808-873-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00476800225X00000X
HI1111225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist