Provider Demographics
NPI:1336233915
Name:LEGER, KIMBERLY S (OTR/L)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:LEGER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:S
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9315 GRAVELLY LAKE DR SW
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499
Mailing Address - Country:US
Mailing Address - Phone:253-581-5200
Mailing Address - Fax:253-581-5203
Practice Address - Street 1:8011 112TH ST CT E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373
Practice Address - Country:US
Practice Address - Phone:253-848-0662
Practice Address - Fax:253-848-8567
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00004328225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist