Provider Demographics
NPI:1710905146
Name:TYLER, KIMBERLY RENEE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:RENEE
Last Name:TYLER
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 1:4300 NANDINA CT
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-5269
Mailing Address - Country:US
Mailing Address - Phone:706-339-1635
Mailing Address - Fax:706-945-1630
Practice Address - Street 1:4300 NANDINA CT
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-5269
Practice Address - Country:US
Practice Address - Phone:706-339-1635
Practice Address - Fax:706-945-1630
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2579225X00000X
GA3450225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist