Provider Demographics
NPI:1275727216
Name:LAFOUNTAINE, KIMBERLY JEAN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:JEAN
Last Name:LAFOUNTAINE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-1633
Mailing Address - Country:US
Mailing Address - Phone:419-690-5691
Mailing Address - Fax:
Practice Address - Street 1:904 ISAAC ST
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3204
Practice Address - Country:US
Practice Address - Phone:419-691-2483
Practice Address - Fax:419-693-4162
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA01018224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant