MEDICARE: MERCEDES ELLEN KIMM 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	17-04196	KS
2	225X00000X	Occupational Therapist	138422	IA

General Provider Information

NPI Number	:	1730011941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERCEDES ELLEN KIMM OTR/L

Provider Business Mailing Address
First Line	:	602 WARRIOR ST UNIT B
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-0520
Country	:	US
Telephone Number	:	507-210-5871
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 E SPRUCE ST
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-5672
Country	:	US
Telephone Number	:	620-272-2222
Fax Number	:

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

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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