MEDICARE: KIMBERLY PAIGE GOMEZ OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	6991	CA

General Provider Information

NPI Number	:	1396923645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY PAIGE GOMEZ OTR/L

Provider Business Mailing Address
First Line	:	28093 SMYTH DR
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91355-4023
Country	:	US
Telephone Number	:	661-295-0181
Fax Number	:	661-295-9776

Provider Business Practice Location Address
First Line	:	28093 SMYTH DR
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91355-4023
Country	:	US
Telephone Number	:	661-295-0181
Fax Number	:	661-295-9776

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2008
Last Update Date	:	01/26/2012

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