Provider Demographics
NPI:1508360397
Name:HIGGINS, MCKAILA DOLORES (OTR)
Entity type:Individual
Prefix:
First Name:MCKAILA
Middle Name:DOLORES
Last Name:HIGGINS
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 1:4601 ASTERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-3742
Mailing Address - Country:US
Mailing Address - Phone:203-415-6510
Mailing Address - Fax:
Practice Address - Street 1:1206 W CHATHAM ST
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-5246
Practice Address - Country:US
Practice Address - Phone:919-462-9147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11570225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist