Provider Demographics
NPI:1740479963
Name:VEACH, KIMBERLY C (COTA/L)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:C
Last Name:VEACH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2190 OLD ROUTE 146 LOOP
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:IL
Mailing Address - Zip Code:62995-2416
Mailing Address - Country:US
Mailing Address - Phone:618-658-2117
Mailing Address - Fax:
Practice Address - Street 1:2190 OLD ROUTE 146 LOOP
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:IL
Practice Address - Zip Code:62995-2416
Practice Address - Country:US
Practice Address - Phone:618-658-2117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-A3791174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist