1578578282 NPI number — MS. CAITLIN ELIZABETH MCKINNELL OTR/L

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578578282 NPI number — MS. CAITLIN ELIZABETH MCKINNELL OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCKINNELL
Provider First Name:
CAITLIN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578578282
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
80 DENSLOW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST LONGMEADOW
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01028-3103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-526-9969
Provider Business Mailing Address Fax Number:
413-526-9960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 BIRNIE AVE
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01107-1107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-781-1054
Provider Business Practice Location Address Fax Number:
413-439-0026
Provider Enumeration Date:
07/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  9121 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225XH1200X , with the licence number: 9121 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AA49027 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 043527497 . This is a "HNE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 690675 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 043527497 . This is a "CT CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 103355100 . This is a "DEPT. OF LABOR" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 35265 . This is a "BMC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 64-04290 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9715568 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: OT0011 . This is a "BC/BS OF MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 043527497 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 972730 . This is a "NETWORK HELATH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 043527497 . This is a "GIC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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