Healthcare Provider Details

I. General information

NPI: 1932612165
Provider Name (Legal Business Name): KIMBERLY LIND OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 FAIRVIEW RD STE 230
MOORESVILLE NC
28117-9508
US

IV. Provider business mailing address

4601 PARK RD STE 300
CHARLOTTE NC
28209-2290
US

V. Phone/Fax

Practice location:
  • Phone: 704-323-2921
  • Fax:
Mailing address:
  • Phone: 704-323-3611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number11441
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: