Provider Demographics
NPI:1477987600
Name:CHARETTE, KIMBERLY R (OTR/L)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:CHARETTE
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 MONMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:BRADLEY BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07720-1149
Mailing Address - Country:US
Mailing Address - Phone:848-469-0595
Mailing Address - Fax:
Practice Address - Street 1:166 PATTERSON AVE
Practice Address - Street 2:STE B
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4176
Practice Address - Country:US
Practice Address - Phone:732-842-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTR00175900225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics