Provider Demographics
NPI:1790883197
Name:CHADD, KIMBERLY DAWN (ATC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DAWN
Last Name:CHADD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:DAWN
Other - Last Name:LIGHTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:IN
Mailing Address - Zip Code:47965-0276
Mailing Address - Country:US
Mailing Address - Phone:765-866-1484
Mailing Address - Fax:
Practice Address - Street 1:1700 LAFAYETTE RD.
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933
Practice Address - Country:US
Practice Address - Phone:765-376-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000388A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist