Provider Demographics
NPI:1003416314
Name:COUSE, KIMBERLY ANN
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANN
Last Name:COUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 DAVY DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1348
Mailing Address - Country:US
Mailing Address - Phone:585-737-9725
Mailing Address - Fax:
Practice Address - Street 1:600 PARDEE RD
Practice Address - Street 2:
Practice Address - City:IRONDEQUOIT
Practice Address - State:NY
Practice Address - Zip Code:14609-2810
Practice Address - Country:US
Practice Address - Phone:585-339-1376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025096225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist