Provider Demographics
NPI:1669040127
Name:WOULFE, KIM D (OTR/L, CDRS)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:D
Last Name:WOULFE
Suffix:
Gender:F
Credentials:OTR/L, CDRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 MOORE RD NW
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:TN
Mailing Address - Zip Code:37310-5031
Mailing Address - Country:US
Mailing Address - Phone:423-505-0551
Mailing Address - Fax:
Practice Address - Street 1:1070 MOORE RD NW
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:TN
Practice Address - Zip Code:37310-5031
Practice Address - Country:US
Practice Address - Phone:423-505-0551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community Mobility