Basic Information
| Provider Information | |||||||||
| NPI: | 1841711710 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KINSEY | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | OTL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 313 STRAND AVE | ||||||||
| Address2: | |||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598015714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062397849 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3018 RATTLESNAKE DR | ||||||||
| Address2: | |||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598026101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4065490988 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2017 | ||||||||
| LastUpdateDate: | 06/30/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 154 | MT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.