Healthcare Provider Details

I. General information

NPI: 1942273024
Provider Name (Legal Business Name): KIMBERLY SUE DEHN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIMBERLY SUE BENSON OTR/L

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 JACOBSGAARD LN
CAMINO CA
95709-9107
US

IV. Provider business mailing address

4000 JACOBSGAARD LN
CAMINO CA
95709-9107
US

V. Phone/Fax

Practice location:
  • Phone: 530-295-3948
  • Fax:
Mailing address:
  • Phone: 530-295-3948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2055026
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: