Provider Demographics
NPI:1831662329
Name:HINCH, KELLYE
Entity Type:Individual
Prefix:
First Name:KELLYE
Middle Name:
Last Name:HINCH
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 1:1426 TAYLORS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38572-6801
Mailing Address - Country:US
Mailing Address - Phone:931-200-2391
Mailing Address - Fax:
Practice Address - Street 1:1426 TAYLORS CHAPEL RD
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38572-6801
Practice Address - Country:US
Practice Address - Phone:931-200-2391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3277225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist