Provider Demographics
NPI:1902003239
Name:HUBBS, KIMBERLEY B (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:B
Last Name:HUBBS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 MOCKINGBIRD HILL DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8007
Mailing Address - Country:US
Mailing Address - Phone:859-626-1895
Mailing Address - Fax:
Practice Address - Street 1:411 BERTHA WALLACE DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336-9418
Practice Address - Country:US
Practice Address - Phone:606-723-5153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR0831225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY185339Medicaid