Provider Demographics
NPI:1346448271
Name:OSBOURN, KIM R (OT)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:R
Last Name:OSBOURN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 CAVE RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-8771
Mailing Address - Country:US
Mailing Address - Phone:270-789-3567
Mailing Address - Fax:
Practice Address - Street 1:1980 OLD GREENSBURG RD
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-2536
Practice Address - Country:US
Practice Address - Phone:270-465-3506
Practice Address - Fax:270-789-4010
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1211225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1457424160Medicaid