Provider Demographics
NPI:1063065902
Name:HIGGINS, KAITLYN ANN (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ANN
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 N GREEN ST
Mailing Address - Street 2:
Mailing Address - City:VALENTINE
Mailing Address - State:NE
Mailing Address - Zip Code:69201-1932
Mailing Address - Country:US
Mailing Address - Phone:402-376-2525
Mailing Address - Fax:
Practice Address - Street 1:510 N GREEN ST
Practice Address - Street 2:
Practice Address - City:VALENTINE
Practice Address - State:NE
Practice Address - Zip Code:69201-1932
Practice Address - Country:US
Practice Address - Phone:402-376-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2344225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty