Healthcare Provider Details

I. General information

NPI: 1528375805
Provider Name (Legal Business Name): KIMBERLY R ESPOSITO OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY R BARNES

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 S HIGHLAND AVE
LOMBARD IL
60148-4932
US

IV. Provider business mailing address

1860 PAYSPHERE CIR
CHICAGO IL
60674-0001
US

V. Phone/Fax

Practice location:
  • Phone: 630-873-8860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056001152
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number056001152
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: