Healthcare Provider Details

I. General information

NPI: 1497429153
Provider Name (Legal Business Name): KIMBERLY A OCHOA MS, OTR/L, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7231 W NORTH LN
PEORIA AZ
85345-6735
US

IV. Provider business mailing address

9450 W CABELA DR APT 2135
GLENDALE AZ
85305-1312
US

V. Phone/Fax

Practice location:
  • Phone: 623-412-4475
  • Fax:
Mailing address:
  • Phone: 310-872-9342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTH-008533
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: