Provider Demographics
NPI:1710271374
Name:TRIPLE E OT INC
Entity Type:Organization
Organization Name:TRIPLE E OT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:EVELYN
Authorized Official - Last Name:HYDLE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:850-401-1227
Mailing Address - Street 1:450 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32433-4058
Mailing Address - Country:US
Mailing Address - Phone:850-401-1227
Mailing Address - Fax:850-682-7463
Practice Address - Street 1:4100 S FERDON BLVD
Practice Address - Street 2:SUITE C1
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-5252
Practice Address - Country:US
Practice Address - Phone:850-682-8388
Practice Address - Fax:850-682-7463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT5156225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty