Healthcare Provider Details

I. General information

NPI: 1346018249
Provider Name (Legal Business Name): KIMBERLEY ROSE WOODS OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2023
Last Update Date: 12/20/2023
Certification Date: 12/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22502 SAMBAR LOOP
CHUGIAK AK
99567-5377
US

IV. Provider business mailing address

22502 SAMBAR LOOP
CHUGIAK AK
99567-5377
US

V. Phone/Fax

Practice location:
  • Phone: 907-726-4663
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number195977
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: