Provider Demographics
NPI:1629169537
Name:KINSELLA, MICHELLE G (OTR)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:G
Last Name:KINSELLA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:59 SHEFFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-2314
Mailing Address - Country:US
Mailing Address - Phone:603-622-0909
Mailing Address - Fax:603-622-2869
Practice Address - Street 1:59 SHEFFIELD RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-2314
Practice Address - Country:US
Practice Address - Phone:603-622-0909
Practice Address - Fax:603-622-2869
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0211225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH7969232OtherAETNA
NH30414296Medicaid
NH30414296Medicaid
NH7969232OtherAETNA