Provider Demographics
NPI:1700063153
Name:MARSALA, KIMBERLEE HUDSON (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEE
Middle Name:HUDSON
Last Name:MARSALA
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 1:2804 ANITA LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3102
Mailing Address - Country:US
Mailing Address - Phone:318-801-1035
Mailing Address - Fax:
Practice Address - Street 1:1816 GLENMAR AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-4932
Practice Address - Country:US
Practice Address - Phone:318-801-1035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ12261225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist