Healthcare Provider Details

I. General information

NPI: 1023334265
Provider Name (Legal Business Name): KIMBERLY THOMPSON OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 HIGH ST
BOWLING GREEN KY
42101-1746
US

IV. Provider business mailing address

6101 FULTON RD
SPRINGFIELD TN
37172-8116
US

V. Phone/Fax

Practice location:
  • Phone: 270-843-3296
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberR2085
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: