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Individual

KIMBERLY LASHAE VICKERY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA

Contact information

Practice address
1645 FLORENCE RD, SAVANNAH, TN 38372-5210
(731) 926-4200
(731) 926-4205
Mailing address
133 JORDAN LN, PARSONS, TN 38363-5078
(731) 847-7240

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2184
TN

Other

Enumeration date
05/14/2013
Last updated
05/14/2013
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