Provider Demographics
NPI:1568008753
Name:SANDERS, KIMBERLY (COTA/L)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12400 SOMERSET PLACE DR APT L
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2237
Mailing Address - Country:US
Mailing Address - Phone:314-435-4827
Mailing Address - Fax:
Practice Address - Street 1:12335 W BEND DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2160
Practice Address - Country:US
Practice Address - Phone:314-435-4827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO12345OtherNBCOT