Provider Demographics
NPI:1730549726
Name:MCKINLEY, LEELIA
Entity type:Individual
Prefix:
First Name:LEELIA
Middle Name:
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235C TACKETTS MILL DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-3036
Mailing Address - Country:US
Mailing Address - Phone:703-491-1044
Mailing Address - Fax:703-491-2044
Practice Address - Street 1:2235C TACKETTS MILL DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-3036
Practice Address - Country:US
Practice Address - Phone:703-491-1044
Practice Address - Fax:703-491-2044
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006833225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics