Provider Demographics
NPI:1275723686
Name:NEGUS, KIMBERLY ANN (COTA/MUSIC THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:NEGUS
Suffix:
Gender:F
Credentials:COTA/MUSIC THERAPIST
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:LIEBERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/MUSIC THERAPIST
Mailing Address - Street 1:S 806 COUNTY ROAD H
Mailing Address - Street 2:
Mailing Address - City:MONDOVI
Mailing Address - State:WI
Mailing Address - Zip Code:54755-8210
Mailing Address - Country:US
Mailing Address - Phone:715-946-3599
Mailing Address - Fax:
Practice Address - Street 1:S 806 COUNTY ROAD H
Practice Address - Street 2:
Practice Address - City:MONDOVI
Practice Address - State:WI
Practice Address - Zip Code:54755-8210
Practice Address - Country:US
Practice Address - Phone:715-946-3599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1617027224Z00000X
MN201093224Z00000X
WI28-038225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant