Provider Demographics
NPI:1154596385
Name:KIRBY, KATHLEEN JOY (OTR)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:JOY
Last Name:KIRBY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 IDAHO AVENUE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2071
Mailing Address - Country:US
Mailing Address - Phone:402-721-9224
Mailing Address - Fax:402-753-6129
Practice Address - Street 1:2603 IDAHO AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2071
Practice Address - Country:US
Practice Address - Phone:402-721-2329
Practice Address - Fax:402-753-6129
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE777225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist