Provider Demographics
NPI:1790239275
Name:KINSALA, AMY (COTA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:KINSALA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5840 S MEMORIAL DR STE 302
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-9037
Mailing Address - Country:US
Mailing Address - Phone:918-699-4250
Mailing Address - Fax:
Practice Address - Street 1:5800 E SKELLY DR
Practice Address - Street 2:SUITE 402
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6471
Practice Address - Country:US
Practice Address - Phone:918-497-1068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-12
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1275246R00000X, 224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No246R00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Pathology