Kevin Boutin, O.T.

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT1239 Issued in MS

Practice address

90 Clark Ave # a
Tupelo, MS 38804-2801

Phone

(662) 840-0535

Fax

(662) 842-7915

NPI assigned

Dec 28, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Tri-Vista Rehab, Inc

  • Physical Therapist
  • Tupelo, MS
  • NPI 1982799516

  Occupational Therapist

  Medicare reassignment NPD Authorized official
• Tri-Vista Rehab, Inc

  dba TriVista Rehab at Community Development Inc.

  • Rehabilitation Clinic/Center
  • Richton, MS
  • NPI 1265025522
  NPD Authorized official
• Shiloh Ridge Athletic Club

  • Physical Therapy Clinic/Center
  • Corinth, MS
  • NPI 1205061173
  NPD (past) Authorized official
• Tri-Vista Rehab, Inc

  • Assisted Living Facility
  • Tupelo, MS
  • NPI 1144577339
  NPD (past) Authorized official
• Tri-Vista Rehab, Inc

  dba TriVista Rehab at Riverbirch Residence

  • Rehabilitation Clinic/Center
  • Plantersville, MS
  • NPI 1386240893
  NPD (past) Authorized official
• Tri-Vista Rehab, Inc.

  • Physical Therapist
  • Birmingham, AL
  • NPI 1134540222
  Authorized official Same address or phone
• Tri-Vista Rehab, Inc.

  • Physical Therapy Clinic/Center
  • Vestavia, AL
  • NPI 1942581277
  NPD (past) Authorized official
• Tri-Vista Rehab, Inc.

  • Physical Therapist
  • Birmingham, AL
  • NPI 1962803932

  Occupational Therapist

  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1780740456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 CLARK AVE # A",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388042801",
            "telephone_number": "662-840-0535",
            "fax_number": "662-842-7915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 CLARK AVE # A",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388042801",
            "telephone_number": "662-840-0535",
            "fax_number": "662-842-7915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUTIN",
        "first_name": "KEVIN",
        "name_prefix": "Mr.",
        "credential": "O.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-28",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MS",
            "license": "OT1239",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00123797",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samantha Grace Boren, PMHNP-BC
• Sharon Dugas Boudreaux, BCBA
• Charles Edward Bouldin, R.P.T.
• Keisha Bounds
• Makenna Bourland, PA-C
• Ronondo Jerome Bowen, MS
• Shirley Jean Bowers, LSW, BA
• Brittany Rachael Box, PTA
• Martha Leanne Box
• Kathleen Boyd

• Occupational Therapist in Tupelo, MS
• Providers in Tupelo, MS by specialty
• Occupational Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.