MEDICARE: MR. KENDALL HUTCHINSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225800000X	Recreation Therapist	6776	TX

General Provider Information

NPI Number	:	1114858677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENDALL HUTCHINSON

Provider Business Mailing Address
First Line	:	7923 BLACKHAWK PASS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-6586
Country	:	US
Telephone Number	:	334-663-1297
Fax Number	:

Provider Business Practice Location Address
First Line	:	7923 BLACKHAWK PASS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-6586
Country	:	US
Telephone Number	:	334-663-1297
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2026
Last Update Date	:	05/26/2026

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