MEDICARE: KIMBERLY M ROSS OTR L,CHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	375157-4201	UT
2	225XH1200X	Hand Occupational Therapist	375157-4201	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00183940	OTHER	UT	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	68950	OTHER	UT	PEHP
2	5417	OTHER	UT	DMBA
4	1108540001	OTHER	UT	CIGNA DMERC
5	6826064002	OTHER	UT	CIGNA
6	870388269BR1	OTHER	UT	EDUCATORS MUTUAL
7	99375157403001	OTHER	UT	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1174524862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY M ROSS OTR L,CHT

Provider Business Mailing Address
First Line	:	6340 S 3000 E STE 200
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-3552
Country	:	US
Telephone Number	:	801-743-4500
Fax Number	:	435-655-2388

Provider Business Practice Location Address
First Line	:	6340 S 3000 E STE 200
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-3552
Country	:	US
Telephone Number	:	801-743-4500
Fax Number	:	435-655-2388

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	12/30/2025

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