Provider Demographics
NPI:1891727905
Name:KUEBRICH, KIMBERLY ELLEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ELLEN
Last Name:KUEBRICH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:JERSEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62052-1559
Mailing Address - Country:US
Mailing Address - Phone:618-604-4158
Mailing Address - Fax:618-639-0607
Practice Address - Street 1:600 N LIBERTY ST
Practice Address - Street 2:
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052-1559
Practice Address - Country:US
Practice Address - Phone:618-604-4158
Practice Address - Fax:618-639-0607
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics