Provider Demographics
NPI:1710097738
Name:HYCHE, KAREN LEA (ODT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:LEA
Last Name:HYCHE
Suffix:
Gender:F
Credentials:ODT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1772
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35502
Mailing Address - Country:US
Mailing Address - Phone:205-471-5713
Mailing Address - Fax:844-269-8087
Practice Address - Street 1:700 HWY 78 W
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501
Practice Address - Country:US
Practice Address - Phone:205-471-5713
Practice Address - Fax:844-269-8087
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2347225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL890010630Medicaid
AL51518365OtherBCBS PROVIDER #