Provider Demographics
NPI:1649003377
Name:HIATT, KYNDALL FAYE (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:KYNDALL
Middle Name:FAYE
Last Name:HIATT
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 W MOREHEAD ST APT 207
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-5834
Mailing Address - Country:US
Mailing Address - Phone:276-733-1394
Mailing Address - Fax:
Practice Address - Street 1:16455 STATESVILLE RD STE 300
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7139
Practice Address - Country:US
Practice Address - Phone:704-863-5040
Practice Address - Fax:704-863-5876
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17107225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist