Provider Demographics
NPI:1407380488
Name:HUBER, KINDELAN
Entity Type:Individual
Prefix:
First Name:KINDELAN
Middle Name:
Last Name:HUBER
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 1:913 RIVER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ASPINWALL
Mailing Address - State:PA
Mailing Address - Zip Code:15215-1616
Mailing Address - Country:US
Mailing Address - Phone:330-571-1791
Mailing Address - Fax:
Practice Address - Street 1:410 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:TARENTUM
Practice Address - State:PA
Practice Address - Zip Code:15084-1810
Practice Address - Country:US
Practice Address - Phone:724-594-0676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC015002225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist