Individual
KIMBERLY BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2403 BATTLEFIELD PKWY, FORT OGLETHORPE, GA 30742-4033
(706) 866-7700
Mailing address
71 CLARK RD, TUNNEL HILL, GA 30755-6800
(423) 463-6531
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
2530
TN
224Z00000X
Occupational Therapy Assistant
Primary
OTA001922
GA
Other
Enumeration date
08/28/2015
Last updated
08/28/2015
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