Provider Demographics
NPI:1861675514
Name:BUDKE, KIMBERLEE JOY (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEE
Middle Name:JOY
Last Name:BUDKE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MS
Other - First Name:KIMBERLEE
Other - Middle Name:JOY
Other - Last Name:DECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 467
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:KS
Mailing Address - Zip Code:67420-0467
Mailing Address - Country:US
Mailing Address - Phone:785-738-3516
Mailing Address - Fax:785-738-9909
Practice Address - Street 1:815 NORTH INDEPENDENCE
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:KS
Practice Address - Zip Code:67420
Practice Address - Country:US
Practice Address - Phone:785-738-9907
Practice Address - Fax:785-738-9909
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1701417225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist