Provider Demographics
NPI:1740509983
Name:REAVES, KIMBERLY LOVE (OTR/L)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LOVE
Last Name:REAVES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:LOVE
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:6704 TACOMA MALL BLVD
Mailing Address - Street 2:100
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-9001
Mailing Address - Country:US
Mailing Address - Phone:253-475-7466
Mailing Address - Fax:
Practice Address - Street 1:6704 TACOMA MALL BLVD
Practice Address - Street 2:100
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-9001
Practice Address - Country:US
Practice Address - Phone:253-475-7466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00003863225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist