Jacqueline Young McKillop

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

014468-1 Issued in NY

Practice address

174 Oakdale Rd
Johnson City, NY 13790-1049

Phone

(607) 729-0044

Fax

(607) 729-9994

NPI assigned

Feb 27, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Finger Lakes United Cerebral Palsy, Inc.

  • Clinic/Center
  • Canandaigua, NY
  • NPI 1194835462
  NPD (past)
• United Cerebral Palsy Association of the Rochester Area, Inc.

  • Clinic/Center
  • Rochester, NY
  • NPI 1942275821
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375228800000",
    "number": "1548397698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "174 OAKDALE RD",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137901049",
            "telephone_number": "607-729-0044",
            "fax_number": "607-729-9994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "174 OAKDALE RD",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137901049",
            "telephone_number": "607-729-0044",
            "fax_number": "607-729-9994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKILLOP",
        "first_name": "JACQUELINE",
        "middle_name": "YOUNG",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-27",
        "last_updated": "2013-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NY",
            "license": "014468-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00355344",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "BA0135",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11716304",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chantel Marie McCarthy
• Kristin M McCollough, LCSW
• Alexandra McCormick, AU.D
• Andrea L McCormick, MS OTR/L
• Jennifer McCormick, LCSW
• Matthew James McLain, LMSW
• Nicolette McLain
• Tiffany Ann McLaughlin, MS OTR/L
• Victoria Elizabeth McManus, FNP-C
• McNamara'S Hearing Solutions LLC

• Occupational Therapist in Johnson City, NY
• Providers in Johnson City, NY by specialty
• Occupational Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.