Provider Demographics
NPI:1730656109
Name:COX, KIMBERLY ERIN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ERIN
Last Name:COX
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 ELKTON TRL
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0580
Mailing Address - Country:US
Mailing Address - Phone:903-266-7200
Mailing Address - Fax:
Practice Address - Street 1:2650 ELKTON TRL
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-0580
Practice Address - Country:US
Practice Address - Phone:903-266-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114648225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty