Provider Demographics
NPI:1033370143
Name:HYDLE, KIM EVELYN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:EVELYN
Last Name:HYDLE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32433-4058
Mailing Address - Country:US
Mailing Address - Phone:850-892-9703
Mailing Address - Fax:
Practice Address - Street 1:450 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32433-4058
Practice Address - Country:US
Practice Address - Phone:850-892-9703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT5156225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist