Provider Demographics
NPI:1902101272
Name:MCKINNEY, SANDI CARLINE (COTA/L)
Entity Type:Individual
Prefix:
First Name:SANDI
Middle Name:CARLINE
Last Name:MCKINNEY
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 1:3936 GRADY RD
Mailing Address - Street 2:
Mailing Address - City:EUPORA
Mailing Address - State:MS
Mailing Address - Zip Code:39744-2324
Mailing Address - Country:US
Mailing Address - Phone:662-258-2426
Mailing Address - Fax:
Practice Address - Street 1:804 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-3137
Practice Address - Country:US
Practice Address - Phone:662-494-3640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSTA2207224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant