Provider Demographics
NPI:1730190695
Name:HICKS, KATHRYN GRACE (MOT, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:GRACE
Last Name:HICKS
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1166 OAKWATER DR
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-6104
Mailing Address - Country:US
Mailing Address - Phone:561-795-9394
Mailing Address - Fax:561-753-7022
Practice Address - Street 1:12955 PALMS WEST DR
Practice Address - Street 2:SUITE 202
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4993
Practice Address - Country:US
Practice Address - Phone:561-753-7010
Practice Address - Fax:561-753-7022
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT9968225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist