Provider Demographics
NPI:1972988897
Name:MUSICANTE, KIMBERLY MICHELLE (OT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MICHELLE
Last Name:MUSICANTE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8426 SPRINGER DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6823
Mailing Address - Country:US
Mailing Address - Phone:901-825-7788
Mailing Address - Fax:901-624-8715
Practice Address - Street 1:8426 SPRINGER DR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6823
Practice Address - Country:US
Practice Address - Phone:901-825-7788
Practice Address - Fax:901-624-8715
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0863174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator