Healthcare Provider Details

I. General information

NPI: 1871022756
Provider Name (Legal Business Name): KIMBERLY J EVANS OTR L CHT PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
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

817 S ANAHEIM BLVD UNIT 103
ANAHEIM CA
92805-5295
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number11316
License Number StateCA

VIII. Authorized Official

Name: KIMBERLY J EVANS
Title or Position: OTR/L, CHT
Credential: M.S. OT
Phone: 951-764-4489