Provider Demographics
NPI:1356933154
Name:KINNEY, MARIANA LEONA (OTR/L)
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:LEONA
Last Name:KINNEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:MARIANA
Other - Middle Name:LEONA
Other - Last Name:KINNEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSOT, OTR/L
Mailing Address - Street 1:PO BOX 656
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30562-0656
Mailing Address - Country:US
Mailing Address - Phone:706-970-5897
Mailing Address - Fax:
Practice Address - Street 1:35 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-3139
Practice Address - Country:US
Practice Address - Phone:706-896-2231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007984225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist