Provider Demographics
NPI:1568002319
Name:DYKES, KATHERINE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:DYKES
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 1:1340 VZ CR 4512
Mailing Address - Street 2:
Mailing Address - City:BEN WHEELER
Mailing Address - State:TX
Mailing Address - Zip Code:75754
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1340 VZ CR 4512
Practice Address - Street 2:
Practice Address - City:BEN WHEELER
Practice Address - State:TX
Practice Address - Zip Code:75754
Practice Address - Country:US
Practice Address - Phone:903-802-3288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215810224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant