Provider Demographics
NPI:1215655709
Name:KIMMEL, CARRIE (OTR)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:KIMMEL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1320
Mailing Address - Street 2:
Mailing Address - City:KEKAHA
Mailing Address - State:HI
Mailing Address - Zip Code:96752-1320
Mailing Address - Country:US
Mailing Address - Phone:804-477-4483
Mailing Address - Fax:
Practice Address - Street 1:8140 KEKAHA RD
Practice Address - Street 2:
Practice Address - City:KEKAHA
Practice Address - State:HI
Practice Address - Zip Code:96752
Practice Address - Country:US
Practice Address - Phone:808-337-7655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOT-225-0225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist