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General NPI Number Information
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NPI Number | 1669334017
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Entity Type | Individual
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Provider Name | DEREK KINSELLA CPO(L)
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Gender | Male
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Dates
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Enumeration Date | 11/24/2025
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 1357 DUBLIN RD
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City | COLUMBUS
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State | OH
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Zip | 43215-7046
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Country | US
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Telephone | 614-481-8338
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Fax | 614-486-1885
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Provider Business Mailing Address
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Address Line | 7593 HASTINGS ST
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City | PICKERINGTON
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State | OH
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Zip | 43147-3200
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number | LPO.00359
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License Number State | OH
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