Provider Demographics
NPI:1235970633
Name:HINTON, KEITRA
Entity type:Individual
Prefix:
First Name:KEITRA
Middle Name:
Last Name:HINTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-3852
Mailing Address - Country:US
Mailing Address - Phone:618-208-7576
Mailing Address - Fax:
Practice Address - Street 1:1609 MAUPIN AVE
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-3863
Practice Address - Country:US
Practice Address - Phone:618-789-0818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist