MEDICARE: MR. JEFF KIMMEL 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	225X00000X	Occupational Therapist	879	OK

General Provider Information

NPI Number	:	1700094646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFF KIMMEL OTR

Provider Business Mailing Address
First Line	:	1608 CASTLE ROCK RD
Second Line	:
City	:	YUKON
State	:	OK
Zip	:	73099-4429
Country	:	US
Telephone Number	:	405-354-6808
Fax Number	:	443-886-9080

Provider Business Practice Location Address
First Line	:	1608 CASTLE ROCK RD
Second Line	:
City	:	YUKON
State	:	OK
Zip	:	73099-4429
Country	:	US
Telephone Number	:	405-354-6808
Fax Number	:	443-886-9080

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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