Provider Demographics
NPI:1700122025
Name:PHILLIPS, KIMBERLY JILL (OTA/L)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:JILL
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35652-0636
Mailing Address - Country:US
Mailing Address - Phone:256-412-2038
Mailing Address - Fax:
Practice Address - Street 1:500 JOHN ALDRIDGE DR
Practice Address - Street 2:
Practice Address - City:TUSCUMBIA
Practice Address - State:AL
Practice Address - Zip Code:35674-3000
Practice Address - Country:US
Practice Address - Phone:256-383-4541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2793224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant