Provider Demographics
NPI:1487767745
Name:VAN WIE, KIMI LAUREN (MS, CPO, LPO)
Entity type:Individual
Prefix:
First Name:KIMI
Middle Name:LAUREN
Last Name:VAN WIE
Suffix:
Gender:F
Credentials:MS, CPO, LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 CALYPSO BAY DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-1754
Mailing Address - Country:US
Mailing Address - Phone:713-791-1414
Mailing Address - Fax:713-794-7221
Practice Address - Street 1:2002 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4211
Practice Address - Country:US
Practice Address - Phone:713-791-1414
Practice Address - Fax:713-794-7221
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCPO-1994222Z00000X, 224P00000X
TXLPO-362222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist