Provider Demographics
NPI:1275659617
Name:HINSON, KATHRYN
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:HINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2377
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-2377
Mailing Address - Country:US
Mailing Address - Phone:907-252-7999
Mailing Address - Fax:
Practice Address - Street 1:150 N WILLOW ST
Practice Address - Street 2:SUITE 15
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7701
Practice Address - Country:US
Practice Address - Phone:907-262-5730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1597225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOT1597Medicaid
AKOT1597Medicaid