Basic Information
| Provider Information | |||||||||
| NPI: | 1093046922 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCKIM | ||||||||
| FirstName: | CHRISTI | ||||||||
| MiddleName: | DANIELLE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS, OTR/L, ATP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 207 FRANCK AVE | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402062544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8125960116 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11003 BLUEGRASS PKWY STE 460 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402992392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022665213 | ||||||||
| FaxNumber: | 8008095213 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2010 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XG0600X | 164536 | KY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Gerontology | 225XP0200X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | 225X00000X | 31004237A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.