Healthcare Provider Details

I. General information

NPI: 1760304349
Provider Name (Legal Business Name): KIMBERLY NGUYEN OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 46TH AVE N
KENNETH CITY FL
33709-3104
US

IV. Provider business mailing address

6006 47TH AVE N
KENNETH CITY FL
33709-3517
US

V. Phone/Fax

Practice location:
  • Phone: 727-544-1444
  • Fax:
Mailing address:
  • Phone: 727-637-8348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT21378
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: