Individual
MISS KIMBERLY RENEE MALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, OTR
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
266531
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10902538
—
CO
Enumeration date
02/10/2010
Last updated
11/25/2012
Update your record
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