Provider Demographics
NPI:1942511274
Name:RIECK, KIMBERLY J
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:RIECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:J
Other - Last Name:KWIAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9898 SCOTTISH GLEN CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-3854
Mailing Address - Country:US
Mailing Address - Phone:702-241-5568
Mailing Address - Fax:877-214-5160
Practice Address - Street 1:9898 SCOTTISH GLEN CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178
Practice Address - Country:US
Practice Address - Phone:702-241-5568
Practice Address - Fax:877-214-5160
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2018-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.005630225X00000X
NV14-0451225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist