Provider Demographics
NPI:1437253796
Name:DIEKEN, KIMBERLI KAYE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLI
Middle Name:KAYE
Last Name:DIEKEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386
Mailing Address - Country:US
Mailing Address - Phone:952-443-9888
Mailing Address - Fax:952-443-9804
Practice Address - Street 1:1772 STIEGER LAKE LANE
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:MN
Practice Address - Zip Code:55386
Practice Address - Country:US
Practice Address - Phone:952-443-9888
Practice Address - Fax:952-443-9804
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100858225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
78B63DIOtherBCBS MN
6402175OtherMEDICA
HP32569OtherHEALTH PARTNERS