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General NPI Number Information
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NPI Number | 1093013906
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Entity Type | Individual
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Provider Name | KIMBERLY ANN MAINER MS, OTR/L, CLT-LANA
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Gender | Female
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Dates
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Enumeration Date | 03/02/2011
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 2321 HENRY CLOWER BLVD STE A
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City | SNELLVILLE
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State | GA
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Zip | 30078-7419
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Country | US
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Telephone | 770-802-4446
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Fax | 770-802-4464
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Provider Business Mailing Address
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Address Line | 2320 HENRY CLOWER BLVD STE A
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City | SNELLVILLE
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State | GA
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Zip | 30078-7425
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Country | US
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Telephone | 770-802-4446
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Fax | 770-802-4464
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XL0004X
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Taxonomy Name | Low Vision Occupational Therapist
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License Number | OT002000
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT002000
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License Number State | GA
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