MEDICARE: MRS. CHRISTINE ANN KIMBLE OTR

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	225XP0200X	Pediatric Occupational Therapist	OT11304	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245238963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINE ANN KIMBLE OTR

Provider Business Mailing Address
First Line	:	34 SENTINEL TRL
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-5413
Country	:	US
Telephone Number	:	954-588-8210
Fax Number	:

Provider Business Practice Location Address
First Line	:	34 SENTINEL TRL
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-5413
Country	:	US
Telephone Number	:	954-588-8210
Fax Number	:

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/08/2007

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