Provider Demographics
NPI:1124347596
Name:SPEARS, KIMBERLY (COTA/L)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:SPEARS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45404-1633
Mailing Address - Country:US
Mailing Address - Phone:937-219-6278
Mailing Address - Fax:
Practice Address - Street 1:709 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404-1633
Practice Address - Country:US
Practice Address - Phone:937-219-6278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH04133224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant