Provider Demographics
NPI:1336545409
Name:KINNAN, MALONNA (COTA/L)
Entity Type:Individual
Prefix:
First Name:MALONNA
Middle Name:
Last Name:KINNAN
Suffix:
Gender:F
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 1:3840 VALLEY VIEW RD
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-0922
Mailing Address - Country:US
Mailing Address - Phone:740-607-4917
Mailing Address - Fax:
Practice Address - Street 1:119 UNION ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-3937
Practice Address - Country:US
Practice Address - Phone:740-349-1644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH04075224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant