Provider Demographics
NPI:1639320054
Name:RICHARDSON, KEVIN E (OTR, CHT PHD)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:E
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:OTR, CHT PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:67972 NICOLE CT
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-6896
Mailing Address - Country:US
Mailing Address - Phone:760-902-2274
Mailing Address - Fax:
Practice Address - Street 1:71703 HIGHWAY 111 STE 1D
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4478
Practice Address - Country:US
Practice Address - Phone:760-501-1572
Practice Address - Fax:760-406-5887
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9619225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist