Kimberly Black, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

OTA001922 Issued in GA

Practice address

2403 Battlefield Pkwy
Fort Oglethorpe, GA 30742-4033

Phone

(706) 866-7700

NPI assigned

Aug 28, 2015

Last updated

Aug 28, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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": "1440720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440720000000",
    "number": "1326415043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "71 CLARK RD",
            "city": "TUNNEL HILL",
            "state": "GA",
            "postal_code": "307556800",
            "telephone_number": "423-463-6531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2403 BATTLEFIELD PKWY",
            "city": "FORT OGLETHORPE",
            "state": "GA",
            "postal_code": "307424033",
            "telephone_number": "706-866-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "KIMBERLY",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-28",
        "last_updated": "2015-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "GA",
            "license": "OTA001922",
            "primary": true
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "TN",
            "license": "2530",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carly Marie Bervoets
• Allen Taylor Bible, DPT
• Jennifer Knight Bird, PTA
• Taylor Davis Bittle
• Avery Christian Lee Black, HIS
• Juan Bloodworth
• Rachel Bragg, OTD, OTR/L
• Chanity Brooke Brannon
• Danielle Brown
• Jeffrey Kiplyn Brown, PHARM D.

• Occupational Therapy Assistant in Fort Oglethorpe, GA
• Providers in Fort Oglethorpe, GA by specialty
• Occupational Therapy Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2015; 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.