Provider Demographics
NPI:1174176234
Name:OLTMAN, KIMBERLY (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:OLTMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2848 PLEASANT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-9494
Mailing Address - Country:US
Mailing Address - Phone:800-779-4089
Mailing Address - Fax:
Practice Address - Street 1:2848 PLEASANT RD STE 101
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-9494
Practice Address - Country:US
Practice Address - Phone:800-779-4089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4745235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4745OtherSTATE LICENSE