Provider Demographics
NPI:1013404888
Name:PEOPLES, KUMIKO (COTA)
Entity Type:Individual
Prefix:
First Name:KUMIKO
Middle Name:
Last Name:PEOPLES
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:KUMIKO
Other - Middle Name:
Other - Last Name:KINOUCHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2712 HILLSIDE TER
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2513
Mailing Address - Country:US
Mailing Address - Phone:206-327-4141
Mailing Address - Fax:
Practice Address - Street 1:4915 CHARLESTOWN RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9426
Practice Address - Country:US
Practice Address - Phone:812-945-5221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32003271A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant