Kimberly Renae Wilson, OTR

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

3055 Issued in CO

Practice address

208 Country Club Dr
Benton, LA 71006-9463

Phone

(318) 507-9909

NPI assigned

May 27, 2011

Sex

Female

Sole proprietor

Yes

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Nature'S Path OT

  • Occupational Therapist
  • Elbert, CO
  • NPI 1619680873
  NPD Authorized official
• Vision for Living Occupational Therapy Services LLC

  • Low Vision Occupational Therapist
  • Colorado Springs, CO
  • NPI 1164785663
  NPD (past) Authorized official

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

{
    "created_epoch": "1306454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533600000000",
    "number": "1508159229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 COUNTRY CLUB DR",
            "city": "BENTON",
            "state": "LA",
            "postal_code": "710069463",
            "telephone_number": "318-507-9909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 COUNTRY CLUB DR",
            "city": "BENTON",
            "state": "LA",
            "postal_code": "710069463",
            "telephone_number": "318-507-9909"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5819 Adamants Dr",
            "address_purpose": "LOCATION",
            "city": "Colorado Springs",
            "state": "CO",
            "postal_code": "809242021",
            "country_code": "US",
            "telephone_number": "719-641-5993",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KIMBERLY",
        "middle_name": "RENAE",
        "name_prefix": "Mrs.",
        "credential": "OTR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-05-27",
        "last_updated": "2018-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "CO",
            "license": "3055",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jere Welch Thompson, APRN-FNP
• Vicki S Cobb MD & Willis-Knighton Medical Center
• Vista Vision LLC
• Walgreen Co
• Willow Creek Counseling LLC
• WK Palmetto Family Practice
• Wound Care Contractors, LLC

• All providers in Benton, LA
• Pediatric Occupational Therapist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2018; 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.