MEDICARE: KIMBERLY A LOVELACE OT

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	OT9042	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y909J	OTHER	FL	BCBS PROVDER
2	2288818	OTHER	FL	AETNA
3	DA6508	OTHER	FL	RR MCR PROVIDER
4	P00066542	OTHER	FL	RR MCR PROVIDER

General Provider Information

NPI Number	:	1659360410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY A LOVELACE OT

Provider Business Mailing Address
First Line	:	3637 CORTEZ RD W
Second Line	:	STE 103
City	:	BRADENTON
State	:	FL
Zip	:	34210-3106
Country	:	US
Telephone Number	:	941-739-7828
Fax Number	:	941-739-7838

Provider Business Practice Location Address
First Line	:	3637 CORTEZ RD W
Second Line	:	STE 103
City	:	BRADENTON
State	:	FL
Zip	:	34210-3106
Country	:	US
Telephone Number	:	941-739-7828
Fax Number	:	941-739-7838

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

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	10/11/2007

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Directions to “ KIMBERLY A LOVELACE OT” Practice Location

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