Provider Demographics
NPI:1073104253
Name:ORTEGA, KINEISHA J (OTA/L)
Entity Type:Individual
Prefix:MISS
First Name:KINEISHA
Middle Name:J
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 46 BOX 5411
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-9789
Mailing Address - Country:US
Mailing Address - Phone:787-452-6451
Mailing Address - Fax:
Practice Address - Street 1:SEC. VILLA PALMA CALLE 14
Practice Address - Street 2:PARC. 270
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-9789
Practice Address - Country:US
Practice Address - Phone:787-452-6451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001269224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6870953OtherLICENSE NUMBER