Provider Demographics
NPI:1194479592
Name:FAKLER, KIMBERLY JO (MA OTR/L)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JO
Last Name:FAKLER
Suffix:
Gender:F
Credentials:MA OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17004 PARK TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-7140
Mailing Address - Country:US
Mailing Address - Phone:719-433-6993
Mailing Address - Fax:
Practice Address - Street 1:17004 PARK TRAIL DR
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-7140
Practice Address - Country:US
Practice Address - Phone:719-433-6993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-05
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0000709225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist