Provider Demographics
NPI:1366405441
Name:TOWNSEND, KIM RENUART (MSOTR/L CHT)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:RENUART
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:MSOTR/L CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 WAKE FOREST RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7341
Mailing Address - Country:US
Mailing Address - Phone:919-872-3171
Mailing Address - Fax:919-872-6739
Practice Address - Street 1:3404 WAKE FOREST RD
Practice Address - Street 2:SUITE 303
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7341
Practice Address - Country:US
Practice Address - Phone:919-872-3171
Practice Address - Fax:919-872-6739
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0182225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00297472OtherRAILROAD MEDICARE
NC2511171Medicare PIN