Provider Demographics
NPI:1801997085
Name:MOORE, DONNA KIMBERLY (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:KIMBERLY
Last Name:MOORE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:DONNA
Other - Middle Name:KIMBERLY
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:504 LEAF LN
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-4662
Mailing Address - Country:US
Mailing Address - Phone:606-677-9490
Mailing Address - Fax:606-679-4626
Practice Address - Street 1:504 LEAF LN
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-4662
Practice Address - Country:US
Practice Address - Phone:606-677-9490
Practice Address - Fax:606-679-4626
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR3647225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist