Provider Demographics
NPI:1346556834
Name:WHITSON, KAMI (COTA)
Entity type:Individual
Prefix:
First Name:KAMI
Middle Name:
Last Name:WHITSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 PURDUE DR
Mailing Address - Street 2:UNIT 3
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-4763
Mailing Address - Country:US
Mailing Address - Phone:214-949-6565
Mailing Address - Fax:
Practice Address - Street 1:6801 W POLY WEBB RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-3640
Practice Address - Country:US
Practice Address - Phone:817-563-6121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210625224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149984001Medicaid
TX456606Medicare UPIN
TX676535Medicare UPIN