Provider Demographics
NPI:1780805895
Name:CLEVINGER, KIMBERLY VASKO (MA, OT/L)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:VASKO
Last Name:CLEVINGER
Suffix:
Gender:F
Credentials:MA, OT/L
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:VASKO
Other - Last Name:HOFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, OTR/L
Mailing Address - Street 1:3422 COOPER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAWN
Mailing Address - State:TN
Mailing Address - Zip Code:37191-8132
Mailing Address - Country:US
Mailing Address - Phone:502-541-9512
Mailing Address - Fax:
Practice Address - Street 1:3422 COOPER CREEK RD
Practice Address - Street 2:
Practice Address - City:WOODLAWN
Practice Address - State:TN
Practice Address - Zip Code:37191-8132
Practice Address - Country:US
Practice Address - Phone:502-541-9512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY132473225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics