Provider Demographics
NPI:1366810533
Name:HARDIN, KACI (COTA)
Entity type:Individual
Prefix:
First Name:KACI
Middle Name:
Last Name:HARDIN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:KACI
Other - Middle Name:
Other - Last Name:HARDIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA
Mailing Address - Street 1:723 BRADLEY ST
Mailing Address - Street 2:
Mailing Address - City:GROESBECK
Mailing Address - State:TX
Mailing Address - Zip Code:76642-2026
Mailing Address - Country:US
Mailing Address - Phone:254-203-0794
Mailing Address - Fax:
Practice Address - Street 1:5400 LAUREL LAKE DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-2835
Practice Address - Country:US
Practice Address - Phone:254-399-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211907224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant