Provider Demographics
NPI:1972182772
Name:KIMLER, CYNTHIA NICOLE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:NICOLE
Last Name:KIMLER
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LANGSTON COMMONS APT 16-H
Mailing Address - Street 2:OLD HIGHWAY 33-2000
Mailing Address - City:LANGSTON
Mailing Address - State:OK
Mailing Address - Zip Code:73050
Mailing Address - Country:US
Mailing Address - Phone:435-830-3585
Mailing Address - Fax:
Practice Address - Street 1:LANGSTON COMMONS APT 16-H
Practice Address - Street 2:OLD HIGHWAY 33-2000
Practice Address - City:LANGSTON
Practice Address - State:OK
Practice Address - Zip Code:73050
Practice Address - Country:US
Practice Address - Phone:435-830-3585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer