Provider Demographics
NPI:1558948141
Name:SCALES, KIMBERLIE MORIAH
Entity Type:Individual
Prefix:MS
First Name:KIMBERLIE
Middle Name:MORIAH
Last Name:SCALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 TERESA DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-5165
Mailing Address - Country:US
Mailing Address - Phone:214-769-0874
Mailing Address - Fax:
Practice Address - Street 1:605 TERESA DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-5165
Practice Address - Country:US
Practice Address - Phone:214-769-0874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-28
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer