Provider Demographics
NPI:1033291901
Name:PICKENS, KATHLEEN M (OCCUPATIONAL THERAPI)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:PICKENS
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8550 CADENZA LANE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-4923
Mailing Address - Country:US
Mailing Address - Phone:214-328-4309
Mailing Address - Fax:214-328-7486
Practice Address - Street 1:8550 CADENZA LANE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-4923
Practice Address - Country:US
Practice Address - Phone:214-328-4309
Practice Address - Fax:214-328-7486
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX003969225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T2852OtherBLUE CROSS BLUE SHIELD