1164632543 NPI number — KIMBERLY K COUCH OTRL CHT

Table of content: KIMBERLY K COUCH OTRL CHT (NPI 1164632543)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164632543 NPI number — KIMBERLY K COUCH OTRL CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COUCH
Provider First Name:
KIMBERLY
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTRL CHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCORT
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTRL CHT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164632543
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6780 BOWERMAN STREET WEST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WORTHINGTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43085
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-310-5490
Provider Business Mailing Address Fax Number:
614-293-5220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2050 KENNY RD
Provider Second Line Business Practice Location Address:
2ND FLOOR REHAB
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43221-3502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-293-0695
Provider Business Practice Location Address Fax Number:
614-293-5220
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XH1200X , with the licence number:  OT2653 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9911000481 . This is a "CERTIFIED HAND THERAPIST" identifier . This identifiers is of the category "OTHER".




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