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General NPI Number Information
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NPI Number | 1457530602
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Entity Type | Individual
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Provider Name | KURT KINKAIDE HUBBARD OTR/L
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Gender | Male
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 10/24/2007
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Provider Practice Location Address
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Address Line | 1 UNIVERSITY BLVD
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5799
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Country | US
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Telephone | 904-826-0084
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Fax |
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Provider Business Mailing Address
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Address Line | 1309 PADOLA RD
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-0490
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Country | US
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Telephone | 904-940-1308
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 122568
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License Number State | FL
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