Provider Demographics
NPI:1902066905
Name:HOOVER, KIMBERLY DIANE (B ED, OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:DIANE
Last Name:HOOVER
Suffix:
Gender:F
Credentials:B ED, OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 DANIEL DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-6030
Mailing Address - Country:US
Mailing Address - Phone:931-787-1006
Mailing Address - Fax:931-787-1963
Practice Address - Street 1:31 DANIEL DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-6030
Practice Address - Country:US
Practice Address - Phone:931-787-1006
Practice Address - Fax:931-787-1963
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3905225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist