Provider Demographics
NPI:1205303906
Name:HETHERINGTON, KIMBERLEE MARIE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLEE
Middle Name:MARIE
Last Name:HETHERINGTON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 BURCHAM DR
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-3898
Mailing Address - Country:US
Mailing Address - Phone:517-827-1069
Mailing Address - Fax:517-336-1915
Practice Address - Street 1:2700 BURCHAM DR
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-3898
Practice Address - Country:US
Practice Address - Phone:517-827-1069
Practice Address - Fax:517-336-1915
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201004312225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist