MEDICARE: KIMBERLY FRANCES COUNTERMAN 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	225X00000X	Occupational Therapist	5201001781	MI

General Provider Information

NPI Number	:	1922106343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY FRANCES COUNTERMAN OTR

Provider Business Mailing Address
First Line	:	123 GROVE ST
Second Line	:
City	:	ALLEGAN
State	:	MI
Zip	:	49010-1444
Country	:	US
Telephone Number	:	269-673-5504
Fax Number	:

Provider Business Practice Location Address
First Line	:	3491 LINCOLN RD
Second Line	:
City	:	HAMILTON
State	:	MI
Zip	:	49419-9512
Country	:	US
Telephone Number	:	269-751-2150
Fax Number	:	269-751-2140

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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