Provider Demographics
NPI:1861638694
Name:BORNEBY, KIMBERLY (COTA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BORNEBY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 BISHOP RD
Mailing Address - Street 2:
Mailing Address - City:LOUDON
Mailing Address - State:TN
Mailing Address - Zip Code:37774-4205
Mailing Address - Country:US
Mailing Address - Phone:865-408-9847
Mailing Address - Fax:
Practice Address - Street 1:2275 BISHOP RD
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774-4205
Practice Address - Country:US
Practice Address - Phone:865-408-9847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOTA1324224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant