Healthcare Provider Details

I. General information

NPI: 1902044654
Provider Name (Legal Business Name): KIMBERLY JANE WEIGLE OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2009
Last Update Date: 02/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1284 LOGAN ST APT 312
DENVER CO
80203-2478
US

IV. Provider business mailing address

1284 LOGAN ST APT 312
DENVER CO
80203-2478
US

V. Phone/Fax

Practice location:
  • Phone: 207-712-0916
  • Fax:
Mailing address:
  • Phone: 207-712-0916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number2428
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: