Basic Information
| Provider Information | |||||||||
| NPI: | 1154451763 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCKAY | ||||||||
| FirstName: | KERRILYN | ||||||||
| MiddleName: | GAIL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14831 S NORMANDIE AVE APT 21 | ||||||||
| Address2: | |||||||||
| City: | GARDENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902472995 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105029012 | ||||||||
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| Practice Location | |||||||||
| Address1: | 527 CROCKER ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262503300 | ||||||||
| FaxNumber: | 6269101380 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 08/07/2018 | ||||||||
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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 | 225400000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.