MEDICARE: DR. SHIRLEY JEAN MCKINNEY OTD, OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	905	NE
2	225X00000X	Occupational Therapist	01643	IA
3	225X00000X	Occupational Therapist	111664	TX

General Provider Information

NPI Number	:	1811199805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHIRLEY JEAN MCKINNEY OTD, OTR

Provider Business Mailing Address
First Line	:	1505 W RD
Second Line	:
City	:	CENTRAL CITY
State	:	NE
Zip	:	68826-8029
Country	:	US
Telephone Number	:	402-672-4518
Fax Number	:

Provider Business Practice Location Address
First Line	:	1505 W RD
Second Line	:
City	:	CENTRAL CITY
State	:	NE
Zip	:	68826-8029
Country	:	US
Telephone Number	:	402-672-4518
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2007
Last Update Date	:	07/08/2007

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