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General NPI Number Information
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NPI Number | 1457832115
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Entity Type | Individual
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Provider Name | KRISTOPHER KIMBROUGH
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Gender | Male
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Dates
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Enumeration Date | 08/22/2018
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 9922 HIGHWAY 151
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City | SAN ANTONIO
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State | TX
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Zip | 78251-4554
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Country | US
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Telephone | 210-546-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 600 N PEARL ST STE 1100
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City | DALLAS
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State | TX
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Zip | 75201-7495
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Country | US
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Telephone |
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Fax |
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 119322
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License Number State | TX
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