Provider Demographics
NPI:1316986565
Name:SWEENEY, KIM BELLIS (OTR/L)
Entity type:Individual
Prefix:PROF
First Name:KIM
Middle Name:BELLIS
Last Name:SWEENEY
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 1:38626 239TH PL SE
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-8803
Mailing Address - Country:US
Mailing Address - Phone:360-825-7201
Mailing Address - Fax:360-825-7201
Practice Address - Street 1:1425 17TH ST SE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-6367
Practice Address - Country:US
Practice Address - Phone:360-825-7201
Practice Address - Fax:360-825-7201
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7683485Medicaid