Provider Demographics
NPI:1275224057
Name:HICKMAN, KINZEY BRIELLE (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:KINZEY
Middle Name:BRIELLE
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 HILTON AVE APT B
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-6784
Mailing Address - Country:US
Mailing Address - Phone:765-480-2542
Mailing Address - Fax:
Practice Address - Street 1:1715 HILTON AVE APT B
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-6784
Practice Address - Country:US
Practice Address - Phone:765-480-2542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer