MEDICARE: KIMBERLY BRAHM OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	056007459	IL
2	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1063664498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY BRAHM OTR/L

Provider Business Mailing Address
First Line	:	650 ACADEMY DR
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-2421
Country	:	US
Telephone Number	:	847-480-8890
Fax Number	:	847-480-8897

Provider Business Practice Location Address
First Line	:	825 N CASS AVE STE 109
Second Line	:
City	:	WESTMONT
State	:	IL
Zip	:	60559-6401
Country	:	US
Telephone Number	:	630-300-0640
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2008
Last Update Date	:	05/26/2022

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