Provider Demographics
NPI:1962243949
Name:MCCLINTIC, MCKENZIE NICOLE (OTR)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:NICOLE
Last Name:MCCLINTIC
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 1:1105 FOLSOM LN
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-7455
Mailing Address - Country:US
Mailing Address - Phone:317-549-5777
Mailing Address - Fax:
Practice Address - Street 1:105 CONVENTION DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4595
Practice Address - Country:US
Practice Address - Phone:919-460-0560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist