Provider Demographics
NPI:1225436736
Name:RICHEY, KIMBERLY HOPE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:HOPE
Last Name:RICHEY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:GALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17143 TOWNSHIP HIGHWAY 103
Mailing Address - Street 2:
Mailing Address - City:UPPER SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:43351-9518
Mailing Address - Country:US
Mailing Address - Phone:740-816-5741
Mailing Address - Fax:
Practice Address - Street 1:117 JACOB PARROT RD
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326-9506
Practice Address - Country:US
Practice Address - Phone:419-674-4197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.05098224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant