Provider Demographics
NPI:1447712138
Name:ZINTSMASTER, KATHLEEN ANN (OTR)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:ZINTSMASTER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-1545
Mailing Address - Country:US
Mailing Address - Phone:810-444-1920
Mailing Address - Fax:
Practice Address - Street 1:1420 E DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1733
Practice Address - Country:US
Practice Address - Phone:574-307-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31006569A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist