Provider Demographics
NPI:1841645090
Name:BECKER, KIMBERLY (COTA/L)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BECKER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:DOUGHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:4605 CAMELLIA PL
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37216-1801
Mailing Address - Country:US
Mailing Address - Phone:615-319-8145
Mailing Address - Fax:
Practice Address - Street 1:139 MAPLE ROW BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-4487
Practice Address - Country:US
Practice Address - Phone:615-826-7113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN544224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant