Basic Information
Provider Information
NPI: 1295274215
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KINSLOW
FirstName: NORA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: OT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1119
Address2:  
City: PROVIDENCE
State: RI
PostalCode: 029011119
CountryCode: US
TelephoneNumber: 4014571580
FaxNumber: 4018310500
Practice Location
Address1: 2 DUDLEY ST
Address2: SUITE 200
City: PROVIDENCE
State: RI
PostalCode: 029053236
CountryCode: US
TelephoneNumber: 4014571580
FaxNumber: 4018310500
Other Information
ProviderEnumerationDate: 02/23/2017
LastUpdateDate: 02/23/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000XOT01616RIY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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