Provider Demographics
NPI:1164632543
Name:COUCH, KIMBERLY K (OTRL CHT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:COUCH
Suffix:
Gender:F
Credentials:OTRL CHT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:K
Other - Last Name:MCCORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL CHT
Mailing Address - Street 1:6780 BOWERMAN STREET WEST
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085
Mailing Address - Country:US
Mailing Address - Phone:614-310-5490
Mailing Address - Fax:614-293-5220
Practice Address - Street 1:2050 KENNY RD
Practice Address - Street 2:2ND FLOOR REHAB
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3502
Practice Address - Country:US
Practice Address - Phone:614-293-0695
Practice Address - Fax:614-293-5220
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT2653225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
9911000481OtherCERTIFIED HAND THERAPIST