Healthcare Provider Details

I. General information

NPI: 1487190849
Provider Name (Legal Business Name): ADRIAN KUYKENDALL OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 ST.LUKES DRIVE
RICHARDSON TX
75080
US

IV. Provider business mailing address

910 ST.LUKES DRIVE
RICHARDSON TX
75080
US

V. Phone/Fax

Practice location:
  • Phone: 214-232-0505
  • Fax:
Mailing address:
  • Phone: 214-232-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number115264
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: