Basic Information
| Provider Information | |||||||||
| NPI: | 1538580956 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCKEY | ||||||||
| FirstName: | BRENDA | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 410 PROVIDENCE LN NE | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985066927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604934350 | ||||||||
| FaxNumber: | 3604937977 | ||||||||
| Practice Location | |||||||||
| Address1: | 410 PROVIDENCE LN NE | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985066927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604934350 | ||||||||
| FaxNumber: | 3604937977 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2014 | ||||||||
| LastUpdateDate: | 01/02/2014 | ||||||||
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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 | 225XP0200X | 00001300 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 910567732 | 05 | WA | MEDICAID |