MEDICARE: KIMBERLY BENTLEY SOLARI OTR

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	225XP0200X	Pediatric Occupational Therapist	OTT.Z10492	LA

General Provider Information

NPI Number	:	1679679690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY BENTLEY SOLARI OTR

Provider Business Mailing Address
First Line	:	3701 BURGOYNE DR
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-2607
Country	:	US
Telephone Number	:	337-477-7883
Fax Number	:	337-477-7812

Provider Business Practice Location Address
First Line	:	3701 BURGOYNE DR
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-2607
Country	:	US
Telephone Number	:	337-477-7883
Fax Number	:	337-477-7812

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	11/14/2018

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