Provider Demographics
NPI:1023122538
Name:BENNETT, KIMBERLY J (LPAT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 SPRING BANK DRIVE
Mailing Address - Street 2:BUILDING C
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-7553
Mailing Address - Country:US
Mailing Address - Phone:859-982-9052
Mailing Address - Fax:
Practice Address - Street 1:1401 SPRING BANK DRIVE
Practice Address - Street 2:BUILDING C
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-7553
Practice Address - Country:US
Practice Address - Phone:859-982-9052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY114617221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist