Provider Demographics
NPI:1952955726
Name:CAROLAN, KIMBERLY SLONE (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SLONE
Last Name:CAROLAN
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:SLONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTR/L
Mailing Address - Street 1:614 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-4106
Mailing Address - Country:US
Mailing Address - Phone:606-521-0304
Mailing Address - Fax:
Practice Address - Street 1:115 S SALEM DR
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1762
Practice Address - Country:US
Practice Address - Phone:502-331-5478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251105225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist