Kimberly Sue Braddock, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

OTA007843 Issued in OH

Practice address

1440 Deer Trce
Newark, OH 43055-9746

Phone

(740) 405-6544

NPI assigned

Mar 16, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615852800000",
    "number": "1194300608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7171 KECK PARK CIR NW",
            "city": "NORTH CANTON",
            "state": "OH",
            "postal_code": "447206301",
            "telephone_number": "330-498-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1440 DEER TRCE",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430559746",
            "telephone_number": "740-405-6544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADDOCK",
        "first_name": "KIMBERLY",
        "middle_name": "SUE",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-16",
        "last_updated": "2021-03-16",
        "certification_date": "2021-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "OH",
            "license": "OTA007843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donald Andrew Bowsher, FNP
• Jessica May Boyce, RN
• Troy Boyce
• Brianna RL Boyer
• Avery Jolee Boyle
• Cynthia E Bradford, LICDC
• Deborah Jo Bradley, RN
• Judson Carlton Brandenburg
• Trevor Arthur Braukman, LCDCIII
• Carrie Lynn Brehm, PA-C

• Occupational Therapy Assistant in Newark, OH
• Providers in Newark, OH by specialty
• Occupational Therapy Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.