Provider Demographics
NPI:1528409539
Name:RICKEY, KIM RENEE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:RENEE
Last Name:RICKEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 WILLIAM DUNN WAY
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-6118
Mailing Address - Country:US
Mailing Address - Phone:251-455-6680
Mailing Address - Fax:
Practice Address - Street 1:1510 WILLIAM DUNN WAY
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-6118
Practice Address - Country:US
Practice Address - Phone:251-455-6680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1718225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics