Provider Demographics
NPI:1235502931
Name:LOHMAN, KIMBERLY MICHELLE
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MICHELLE
Last Name:LOHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:BECKEMEYER
Mailing Address - State:IL
Mailing Address - Zip Code:62219-0186
Mailing Address - Country:US
Mailing Address - Phone:618-789-3228
Mailing Address - Fax:
Practice Address - Street 1:651 EAST WILSON
Practice Address - Street 2:
Practice Address - City:BECKEMEYER
Practice Address - State:IL
Practice Address - Zip Code:62219
Practice Address - Country:US
Practice Address - Phone:618-789-3228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist