Provider Demographics
NPI:1174733414
Name:KITE, VICTORIA LYNN (OTR)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:LYNN
Last Name:KITE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:VICTORIA
Other - Middle Name:KITE
Other - Last Name:BREWSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:1003 NATION TRL
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-6463
Mailing Address - Country:US
Mailing Address - Phone:423-787-6503
Mailing Address - Fax:
Practice Address - Street 1:4850 E ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-3098
Practice Address - Country:US
Practice Address - Phone:423-787-6503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT0000003544225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist