Provider Demographics
NPI:1154557221
Name:KINCAID, BETH ANN (MOT, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANN
Last Name:KINCAID
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 N 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEECH GROVE
Mailing Address - State:IN
Mailing Address - Zip Code:46107-1102
Mailing Address - Country:US
Mailing Address - Phone:317-908-0202
Mailing Address - Fax:
Practice Address - Street 1:1751 N LITCHFIELD RD
Practice Address - Street 2:APT 1144
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2259
Practice Address - Country:US
Practice Address - Phone:317-908-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4369171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor