Healthcare Provider Details

I. General information

NPI: 1437303120
Provider Name (Legal Business Name): KIMBERLY MARIE SICHENEDER MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY MARIE FOWLER OTR

II. Dates (important events)

Enumeration Date: 11/09/2008
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 3RD ST
FORT JOHNSON LA
71459-5102
US

IV. Provider business mailing address

14214 JUNIPER BREEZE CT
WILLIS TX
77318-1450
US

V. Phone/Fax

Practice location:
  • Phone: 337-718-7289
  • Fax:
Mailing address:
  • Phone: 530-514-2191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number118364
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3494
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: