Provider Demographics
NPI:1174990204
Name:KINSEY, KATELYN JESSICA (OTR)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:JESSICA
Last Name:KINSEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:JESSICA
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:16 ELMER ST APT 503
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-6850
Mailing Address - Country:US
Mailing Address - Phone:954-383-9345
Mailing Address - Fax:
Practice Address - Street 1:16 ELMER ST APT 503
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-6850
Practice Address - Country:US
Practice Address - Phone:954-383-9345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11591225X00000X
TX115886225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist