Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OT7442 | FL |
NPI | 1134158777 |
---|---|
Provider Name | Carla Kimps |
First Address | St Augustine, FL 32080-7661 |
Second Address | St Augustine, FL 32086-4202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 11/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1174540001 | DMERC CIGNA GOVT SVCS (01) | FL |