Healthcare Provider Details

I. General information

NPI: 1104758309
Provider Name (Legal Business Name): KYONNA MARTIN MCCLANEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 CENTER ST
APEX NC
27502-7026
US

IV. Provider business mailing address

PO BOX 749
BELMONT NC
28012-0749
US

V. Phone/Fax

Practice location:
  • Phone: 984-246-9080
  • Fax:
Mailing address:
  • Phone: 704-869-2088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number18463
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: