Provider Demographics
NPI:1174719439
Name:KARIUKI, PETER KIARIE (OTR)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:KIARIE
Last Name:KARIUKI
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 TINA DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-4809
Mailing Address - Country:US
Mailing Address - Phone:903-618-9144
Mailing Address - Fax:903-657-9061
Practice Address - Street 1:1010 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75652-2923
Practice Address - Country:US
Practice Address - Phone:903-657-6945
Practice Address - Fax:903-657-9061
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107169225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist