Healthcare Provider Details

I. General information

NPI: 1295150886
Provider Name (Legal Business Name): KINNECTZ THERAPIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2014
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 N UNION ST
WINONA MS
38967-1718
US

IV. Provider business mailing address

605 N UNION ST
WINONA MS
38967-1718
US

V. Phone/Fax

Practice location:
  • Phone: 662-428-9090
  • Fax:
Mailing address:
  • Phone: 662-428-9090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: MS. SYLVIA EVETTE CLARK
Title or Position: OT COORDINATOR
Credential:
Phone: 662-428-9090