Provider Demographics
NPI:1063800597
Name:TOWNS-ODAIN, KIMBERLEY (OTR/L)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:TOWNS-ODAIN
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 1:400 W 223RD ST APT 104
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-3668
Mailing Address - Country:US
Mailing Address - Phone:310-704-8796
Mailing Address - Fax:
Practice Address - Street 1:400 W 223RD ST APT 104
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-3668
Practice Address - Country:US
Practice Address - Phone:310-704-8796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5840225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist