MEDICARE: MRS. KIMBERLY KAY PHILBRICK 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	OT8473	FL
2	225XP0200X	Pediatric Occupational Therapist	8511	NC
3	225XP0200X	Pediatric Occupational Therapist	3974	SC

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	:	1770545162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY KAY PHILBRICK OTR/L

Provider Business Mailing Address
First Line	:	3209 ALDER CT
Second Line	:
City	:	TEGA CAY
State	:	SC
Zip	:	29708-8615
Country	:	US
Telephone Number	:	407-484-5504
Fax Number	:

Provider Business Practice Location Address
First Line	:	3209 ALDER CT
Second Line	:
City	:	TEGA CAY
State	:	SC
Zip	:	29708-8615
Country	:	US
Telephone Number	:	407-484-5504
Fax Number	:

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

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	02/12/2013

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