Provider Demographics
NPI:1699551556
Name:KIMM, JOSHUA ALLAN (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ALLAN
Last Name:KIMM
Suffix:
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 WARRIOR ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-0520
Mailing Address - Country:US
Mailing Address - Phone:515-210-7598
Mailing Address - Fax:
Practice Address - Street 1:3105 N IBP RD UNIT B
Practice Address - Street 2:
Practice Address - City:HOLCOMB
Practice Address - State:KS
Practice Address - Zip Code:67851-8902
Practice Address - Country:US
Practice Address - Phone:515-210-7598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-04191225XE1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics