Basic Information
| Provider Information | |||||||||
| NPI: | 1790033587 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STROUD | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | |||||||||
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| OtherOrganizationType: | |||||||||
| OtherLastName: | KENDALL | ||||||||
| OtherFirstName: | KIMBERLY | ||||||||
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| OtherCredential: | COTA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2824 COMMODORE LN | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452513204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137411655 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4307 BRIDGETOWN RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452114427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135988000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2012 | ||||||||
| LastUpdateDate: | 08/27/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | OTA-02662 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
ID Information
| ID | Type | State | Issuer | Description | OTA-O2662 | 01 | OH | AD | OTHER |