MEDICARE: KIMBERLY BOCKELMAN

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	3747P1801X	Personal Care Attendant	DZ1114	OR

General Provider Information

NPI Number	:	1598341638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY BOCKELMAN

Provider Business Mailing Address
First Line	:	PO BOX 411
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-0023
Country	:	US
Telephone Number	:	541-331-3434
Fax Number	:

Provider Business Practice Location Address
First Line	:	735 RIVERSIDE DR
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-4257
Country	:	US
Telephone Number	:	541-273-7112
Fax Number	:

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

Provider Enumeration Date	:	03/19/2021
Last Update Date	:	03/19/2021

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Directions to “ KIMBERLY BOCKELMAN ” Practice Location

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