Provider Demographics
NPI:1164021119
Name:KINSMAN, CARLA ADRIENNE (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:ADRIENNE
Last Name:KINSMAN
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4513 HUNTERS CIR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-2217
Mailing Address - Country:US
Mailing Address - Phone:757-642-3803
Mailing Address - Fax:
Practice Address - Street 1:302 DARE RD
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23692-2716
Practice Address - Country:US
Practice Address - Phone:757-898-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119001818225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist