Provider Demographics
NPI:1811224728
Name:KINAVEY, JACQUELYN SUE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:SUE
Last Name:KINAVEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 E GUADALUPE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3277
Mailing Address - Country:US
Mailing Address - Phone:480-456-0942
Mailing Address - Fax:
Practice Address - Street 1:1835 E GUADALUPE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3277
Practice Address - Country:US
Practice Address - Phone:480-456-0942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2A01922029225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist