Provider Demographics
NPI:1316467327
Name:GINN, KYLE
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:GINN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 RALPH MCGILL BLVD NE APT 2507
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1155
Mailing Address - Country:US
Mailing Address - Phone:678-262-7435
Mailing Address - Fax:
Practice Address - Street 1:10050 EAGLE DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-3804
Practice Address - Country:US
Practice Address - Phone:678-607-6715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT18584225X00000X
GAOT007045225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist