Provider Demographics
NPI:1255318473
Name:FOSTER, KIMBERLY AUNDRE' (COTA-L)
Entity Type:Individual
Prefix:MR
First Name:KIMBERLY
Middle Name:AUNDRE'
Last Name:FOSTER
Suffix:
Gender:M
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 1:1904 GRANDSTAND DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-4508
Mailing Address - Country:US
Mailing Address - Phone:210-520-8070
Mailing Address - Fax:210-521-7688
Practice Address - Street 1:1904 GRANDSTAND DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-4508
Practice Address - Country:US
Practice Address - Phone:210-520-8070
Practice Address - Fax:210-521-7688
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209498247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other