Provider Demographics
NPI:1912214396
Name:PATTERSON, KIMBERLEY MARIE (COTA)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:MARIE
Last Name:PATTERSON
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 1:905 SOUTHWEST AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6678
Mailing Address - Country:US
Mailing Address - Phone:941-587-8749
Mailing Address - Fax:
Practice Address - Street 1:175 HETCHELTOWN RD
Practice Address - Street 2:
Practice Address - City:SCOTIA
Practice Address - State:NY
Practice Address - Zip Code:12302-5821
Practice Address - Country:US
Practice Address - Phone:518-557-2792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007590-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant