Provider Demographics
NPI:1720073836
Name:CHILDERS DEATON, KIMBERLY A (OTR/L, CHT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:A
Last Name:CHILDERS DEATON
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 PEDRO WAY
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-8354
Mailing Address - Country:US
Mailing Address - Phone:859-745-2152
Mailing Address - Fax:859-745-2153
Practice Address - Street 1:160 PEDRO WAY
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-8354
Practice Address - Country:US
Practice Address - Phone:859-745-2152
Practice Address - Fax:859-745-2153
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR0823225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5029532Medicare Oscar/Certification
0718409Medicare PIN