Healthcare Provider Details

I. General information

NPI: 1346541679
Provider Name (Legal Business Name): KIMBERLY JOYCE EVANS OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W KATELLA AVE STE D
ORANGE CA
92867-3434
US

IV. Provider business mailing address

627 E MEADOWBROOK AVE
ORANGE CA
92865-1319
US

V. Phone/Fax

Practice location:
  • Phone: 714-831-5599
  • Fax: 714-783-3318
Mailing address:
  • Phone: 951-764-4489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT11316
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: