Healthcare Provider Details

I. General information

NPI: 1508059460
Provider Name (Legal Business Name): KIMBERLY AR BARRETT OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIMBERLY A REXIN

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4602 CUMBERLAND RD
FAYETTEVILLE NC
28306-2412
US

IV. Provider business mailing address

700 HEATHROW DR
SPRING LAKE NC
28390-9322
US

V. Phone/Fax

Practice location:
  • Phone: 910-423-5622
  • Fax:
Mailing address:
  • Phone: 248-259-3317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number112368
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberR4259
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number8543
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: