Provider Demographics
NPI:1982105110
Name:KINNEY, LAURA E (COTA/L)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:KINNEY
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 1:11820 N DEAD MANS GULCH RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85132-9146
Mailing Address - Country:US
Mailing Address - Phone:602-529-5989
Mailing Address - Fax:
Practice Address - Street 1:11820 N DEAD MANS GULCH RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85132-9146
Practice Address - Country:US
Practice Address - Phone:602-529-5989
Practice Address - Fax:602-529-5989
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7370224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant