Provider Demographics
NPI:1659603074
Name:MALE, KIMBERLY RENEE (MS, OTR)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:RENEE
Last Name:MALE
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:RENEE
Other - Last Name:MOHRBACHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3401 QUEBEC ST
Mailing Address - Street 2:SUITE 3600
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80207-2322
Mailing Address - Country:US
Mailing Address - Phone:303-432-8487
Mailing Address - Fax:
Practice Address - Street 1:3401 QUEBEC ST
Practice Address - Street 2:SUITE 3600
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80207-2322
Practice Address - Country:US
Practice Address - Phone:303-432-8487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2012-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO266531174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO10902538Medicaid