Basic Information
| Provider Information | |||||||||
| NPI: | 1639651409 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HINTON | ||||||||
| FirstName: | WYATT | ||||||||
| MiddleName: | PALMER | ||||||||
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| Credential: | OTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 113 BUFFALO TRL | ||||||||
| Address2: | |||||||||
| City: | EARLY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 768022522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3253205196 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2500 SONG BIRD CIR | ||||||||
| Address2: | |||||||||
| City: | BROWNWOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 768016488 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3256464750 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2018 | ||||||||
| LastUpdateDate: | 08/29/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 209521 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.