Provider Demographics
NPI:1033453402
Name:KINSELLA, MEGAN LYNN (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:LYNN
Last Name:KINSELLA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:60 GARY L MAIETTA PKWY
Mailing Address - Street 2:UNIT 16
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-7818
Mailing Address - Country:US
Mailing Address - Phone:207-518-9290
Mailing Address - Fax:
Practice Address - Street 1:60 GARY L MAIETTA PKWY
Practice Address - Street 2:UNIT 16
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-7818
Practice Address - Country:US
Practice Address - Phone:207-518-9290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-24
Last Update Date:2012-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOA2687224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant