Provider Demographics
NPI:1225445299
Name:COMBS, KIMBERLY JO (OTR/L)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JO
Last Name:COMBS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 E 4TH AVE
Mailing Address - Street 2:APT A
Mailing Address - City:BUHLER
Mailing Address - State:KS
Mailing Address - Zip Code:67522-2261
Mailing Address - Country:US
Mailing Address - Phone:620-899-2224
Mailing Address - Fax:
Practice Address - Street 1:151 E 4TH AVE
Practice Address - Street 2:APT A
Practice Address - City:BUHLER
Practice Address - State:KS
Practice Address - Zip Code:67522-2261
Practice Address - Country:US
Practice Address - Phone:620-899-2224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-02406225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist