Provider Demographics
NPI:1720597131
Name:KINSLAND, PAUL JUDSON IV (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JUDSON
Last Name:KINSLAND
Suffix:IV
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 CHARLES NOLAN RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28734-8458
Mailing Address - Country:US
Mailing Address - Phone:828-371-2588
Mailing Address - Fax:
Practice Address - Street 1:551 KENT ST
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:NC
Practice Address - Zip Code:28901-8088
Practice Address - Country:US
Practice Address - Phone:828-321-3075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11224224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant