Provider Demographics
NPI:1609026400
Name:KINNAIRD, KEVIN WAYNE (ATC/L)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:WAYNE
Last Name:KINNAIRD
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Gender:M
Credentials:ATC/L
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Mailing Address - Street 1:825 N BROADWAY AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-6039
Mailing Address - Country:US
Mailing Address - Phone:405-609-3675
Mailing Address - Fax:800-506-3795
Practice Address - Street 1:1509 BROOKWOOD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1316
Practice Address - Country:US
Practice Address - Phone:580-252-9159
Practice Address - Fax:580-255-2158
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2010-02-23
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Provider Licenses
StateLicense IDTaxonomies
OKAT1362255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer