Provider Demographics
NPI:1962464941
Name:LEROY, KIMBERLY WHITE (OTR/L)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:WHITE
Last Name:LEROY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ELAINE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:260 FORT SANDERS WEST BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3355
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:260 FORT SANDERS WEST BLVD STE 110
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3355
Practice Address - Country:US
Practice Address - Phone:865-558-4491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5337225X00000X
FLOT12357225XH1200X
TN4393225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1525364Medicaid
TN6096499OtherCIGNA
7259784OtherAETNA
TNP01005605OtherRAILROAD MEDICARE
TN4305876OtherBLUECROSS BLUESHIELD
TN103I670251Medicare PIN