Provider Demographics
NPI:1740583202
Name:COTHRAN, KIMBERLY PAEDAE (OT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:PAEDAE
Last Name:COTHRAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 S CLEARVIEW PKWY RM 108
Mailing Address - Street 2:
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-3401
Mailing Address - Country:US
Mailing Address - Phone:504-736-1865
Mailing Address - Fax:
Practice Address - Street 1:3700 RUE NADINE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-5439
Practice Address - Country:US
Practice Address - Phone:504-421-0768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-06
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
LAOTT.200314174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist