Basic Information
Provider Information | |||||||||
NPI: | 1285022855 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | VERDIER | ||||||||
FirstName: | KIM | ||||||||
MiddleName: | MARIA | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | OTR/L | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | GUTHRIE | ||||||||
OtherFirstName: | KIM | ||||||||
OtherMiddleName: | MARIA | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | OTR/L | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 5672 BRASHER AVE | ||||||||
Address2: |   | ||||||||
City: | BLUE ASH | ||||||||
State: | OH | ||||||||
PostalCode: | 452423918 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5138917318 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 4900 COOPER RD | ||||||||
Address2: |   | ||||||||
City: | BLUE ASH | ||||||||
State: | OH | ||||||||
PostalCode: | 452426915 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5137933362 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/05/2015 | ||||||||
LastUpdateDate: | 01/05/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | OT-1000 | OH | Y |   | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |   |
No ID Information.