Provider Demographics
NPI:1548419054
Name:CAIN, KIMBERLY K (OTR/L)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:CAIN
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 1:230 PRIVATE ROAD 3563
Mailing Address - Street 2:
Mailing Address - City:BALLINGER
Mailing Address - State:TX
Mailing Address - Zip Code:76821-7633
Mailing Address - Country:US
Mailing Address - Phone:325-977-1064
Mailing Address - Fax:
Practice Address - Street 1:1029 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501
Practice Address - Country:US
Practice Address - Phone:918-423-2220
Practice Address - Fax:918-423-2620
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200869690AMedicaid