Provider Demographics
NPI:1457641292
Name:HINSON, ERICA (OTR)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:
Last Name:HINSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 TETON RDG
Mailing Address - Street 2:
Mailing Address - City:LAKE WINNEBAGO
Mailing Address - State:MO
Mailing Address - Zip Code:64034-9466
Mailing Address - Country:US
Mailing Address - Phone:816-805-1673
Mailing Address - Fax:
Practice Address - Street 1:5211 W 103RD ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66207-3154
Practice Address - Country:US
Practice Address - Phone:913-383-2569
Practice Address - Fax:913-383-2611
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1702681225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist