Provider Demographics
NPI:1922593334
Name:HUMMEL, KIRSTEN SUZANNE (OT)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:SUZANNE
Last Name:HUMMEL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 DEMOCRAT ST # 4
Mailing Address - Street 2:
Mailing Address - City:BLANCO
Mailing Address - State:TX
Mailing Address - Zip Code:78606-5846
Mailing Address - Country:US
Mailing Address - Phone:504-206-6056
Mailing Address - Fax:
Practice Address - Street 1:1411 DEMOCRAT ST # 4
Practice Address - Street 2:
Practice Address - City:BLANCO
Practice Address - State:TX
Practice Address - Zip Code:78606-5846
Practice Address - Country:US
Practice Address - Phone:504-206-6056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118860225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist