Provider Demographics
NPI:1174757470
Name:BROWN, KIMBERLY ANN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:BROWN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:O'BUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3830
Mailing Address - Street 2:THERAPEUTIC INNOVATIONS
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27836-1830
Mailing Address - Country:US
Mailing Address - Phone:252-320-6001
Mailing Address - Fax:252-321-6004
Practice Address - Street 1:106 EAST VICTORIA COURT
Practice Address - Street 2:STE D THERAPEUTIC INNOVATIONS
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5708
Practice Address - Country:US
Practice Address - Phone:252-321-6001
Practice Address - Fax:252-321-6004
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7133225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0196MOtherBCBS
NC7210273Medicaid