Provider Demographics
NPI:1265913685
Name:HUNTER, KIM YVETTE (OTA)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:YVETTE
Last Name:HUNTER
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 PERKINS ST
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:75409-5881
Mailing Address - Country:US
Mailing Address - Phone:903-714-0510
Mailing Address - Fax:
Practice Address - Street 1:2301 MARSH LN STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8497
Practice Address - Country:US
Practice Address - Phone:972-695-6479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210463224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant