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General NPI Number Information
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NPI Number | 1235970633
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Entity Type | Individual
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Provider Name | KEITRA HINTON
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Gender | Female
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Dates
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Enumeration Date | 06/03/2024
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Last Update Date | 06/27/2024
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Provider Practice Location Address
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Address Line | 1609 MAUPIN AVE
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City | ALTON
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State | IL
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Zip | 62002-3863
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Country | US
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Telephone | 618-789-0818
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Fax |
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Provider Business Mailing Address
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Address Line | 1311 HIGHLAND AVE
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City | ALTON
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State | IL
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Zip | 62002-3852
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Country | US
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Telephone | 618-208-7576
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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