Provider Demographics
NPI:1083952790
Name:BRUBAKER, KIMBERLY D (COTA/L)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:BRUBAKER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 MONTICELLO AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-4206
Mailing Address - Country:US
Mailing Address - Phone:540-435-9160
Mailing Address - Fax:
Practice Address - Street 1:374 MONTICELLO AVE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-4206
Practice Address - Country:US
Practice Address - Phone:540-435-9160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000891224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant