Healthcare Provider Details

I. General information

NPI: 1114124526
Provider Name (Legal Business Name): KATHLEEN J KIMBERLIN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 SHAVER ST
PASADENA TX
77504-2603
US

IV. Provider business mailing address

25414 SPRING RIDGE DR
SPRING TX
77386-1510
US

V. Phone/Fax

Practice location:
  • Phone: 713-378-0030
  • Fax: 713-378-0399
Mailing address:
  • Phone: 832-275-6111
  • Fax: 281-857-6487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number109107
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: