Provider Demographics
NPI:1467073429
Name:LUPPENS, KIM MARIE (OTR)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:MARIE
Last Name:LUPPENS
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 1:104 E HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-3854
Mailing Address - Country:US
Mailing Address - Phone:281-993-2009
Mailing Address - Fax:
Practice Address - Street 1:104 E HERITAGE DR
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-3854
Practice Address - Country:US
Practice Address - Phone:281-993-2009
Practice Address - Fax:281-993-2007
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105142225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist