Provider Demographics
NPI:1134408008
Name:GOLDBOROUGH, KIMBERLY ALICE (OTR)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ALICE
Last Name:GOLDBOROUGH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 GALLAHER RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-4721
Mailing Address - Country:US
Mailing Address - Phone:865-376-4620
Mailing Address - Fax:865-376-1759
Practice Address - Street 1:187 GALLAHER RD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:TN
Practice Address - Zip Code:37763-4721
Practice Address - Country:US
Practice Address - Phone:865-376-4620
Practice Address - Fax:865-376-1759
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist