Provider Demographics
NPI:1932668332
Name:HYNICK, KELLIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:HYNICK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-3444
Mailing Address - Country:US
Mailing Address - Phone:641-295-2836
Mailing Address - Fax:
Practice Address - Street 1:909 S 9TH ST
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-3444
Practice Address - Country:US
Practice Address - Phone:641-295-2836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant