Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 17817 | FL |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT2134 | ME |
NPI | 1023326709 |
---|---|
Provider Name | Kelly Marie Kinne |
First Address | Venice, FL 34292-2515 |
Second Address | Knoxville, TN 37932-3347 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2010 |
Last Update Date | 17/03/2018 |