Provider Demographics
NPI:1972736668
Name:SUMNER, KIMBERLY C (LOTR)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:C
Last Name:SUMNER
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 ART CAMP LOOP
Mailing Address - Street 2:
Mailing Address - City:HEFLIN
Mailing Address - State:LA
Mailing Address - Zip Code:71039-3316
Mailing Address - Country:US
Mailing Address - Phone:318-377-6539
Mailing Address - Fax:
Practice Address - Street 1:186 ART CAMP LOOP
Practice Address - Street 2:
Practice Address - City:HEFLIN
Practice Address - State:LA
Practice Address - Zip Code:71039-3316
Practice Address - Country:US
Practice Address - Phone:318-377-6539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ10891225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics