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General NPI Number Information
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NPI Number | 1700094646
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Entity Type | Individual
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Provider Name | JEFF KIMMEL OTR
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Gender | Male
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1608 CASTLE ROCK RD
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City | YUKON
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State | OK
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Zip | 73099-4429
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Country | US
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Telephone | 405-354-6808
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Fax | 443-886-9080
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Provider Business Mailing Address
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Address Line | 1608 CASTLE ROCK RD
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City | YUKON
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State | OK
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Zip | 73099-4429
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Country | US
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Telephone | 405-354-6808
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Fax | 443-886-9080
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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 | 879
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License Number State | OK
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