Provider Demographics
NPI:1427456755
Name:KING, KIMBERLY JO (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:JO
Last Name:KING
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 681478
Mailing Address - Street 2:STE 103
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068
Mailing Address - Country:US
Mailing Address - Phone:615-591-6590
Mailing Address - Fax:615-591-6601
Practice Address - Street 1:5505 EDMONDSON PIKE
Practice Address - Street 2:STE 103
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-5872
Practice Address - Country:US
Practice Address - Phone:615-831-1710
Practice Address - Fax:615-831-1968
Is Sole Proprietor?:No
Enumeration Date:2014-12-18
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT0000000594225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN446631Medicare PIN