Healthcare Provider Details

I. General information

NPI: 1134607344
Provider Name (Legal Business Name): ALLYSON CHRISTA MCKINNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLYSON CHRISTA HATFIELD

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 LMMH CENTER ROAD
LOGAN WV
25601
US

IV. Provider business mailing address

PO BOX 334
PINEVILLE WV
24874-0334
US

V. Phone/Fax

Practice location:
  • Phone: 304-752-2273
  • Fax:
Mailing address:
  • Phone: 304-923-5115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberC2180
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: