Provider Demographics
NPI:1629724711
Name:BK OUTFITTERS LLC
Entity Type:Organization
Organization Name:BK OUTFITTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:940-357-1266
Mailing Address - Street 1:2711 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384-6454
Mailing Address - Country:US
Mailing Address - Phone:940-357-1266
Mailing Address - Fax:
Practice Address - Street 1:2711 CENTER DR
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-6454
Practice Address - Country:US
Practice Address - Phone:940-357-1266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BK OUTFITTERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-27
Last Update Date:2022-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty