Provider Demographics
NPI:1710213798
Name:BREEDEN, KIMBERLY RUBLE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:RUBLE
Last Name:BREEDEN
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 1:8107 BURRAY CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23838-5156
Mailing Address - Country:US
Mailing Address - Phone:804-768-9358
Mailing Address - Fax:
Practice Address - Street 1:1257 MARYWOOD LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-6059
Practice Address - Country:US
Practice Address - Phone:804-740-1086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000674225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist