Provider Demographics
NPI:1861702102
Name:KIMBERLY, DANA H (OTR/L)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:H
Last Name:KIMBERLY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8396 SIX FORKS ROAD
Mailing Address - Street 2:SUIET 102
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615
Mailing Address - Country:US
Mailing Address - Phone:919-841-4930
Mailing Address - Fax:919-841-4933
Practice Address - Street 1:8396 SIX FORKS ROAD
Practice Address - Street 2:SUIET 102
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615
Practice Address - Country:US
Practice Address - Phone:919-841-4930
Practice Address - Fax:919-841-4933
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3451225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist