Provider Demographics
NPI:1053692590
Name:MCKENNA, TINA D (COTA)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:D
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6014 S ROUTT ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-4743
Mailing Address - Country:US
Mailing Address - Phone:303-972-2732
Mailing Address - Fax:
Practice Address - Street 1:6535 S DAYTON ST
Practice Address - Street 2:STE. 3800
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-6125
Practice Address - Country:US
Practice Address - Phone:303-649-9007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO287040225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist