Provider Demographics
NPI:1699936500
Name:MEYER, KIMBERLY SUE (OTR)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:SUE
Last Name:MEYER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11725 101ST ST
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-2352
Mailing Address - Country:US
Mailing Address - Phone:727-432-5339
Mailing Address - Fax:
Practice Address - Street 1:515 129TH AVE E
Practice Address - Street 2:APT 2
Practice Address - City:MADEIRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33708-2605
Practice Address - Country:US
Practice Address - Phone:407-718-7770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT13255225XP0019X
FLOT 13255225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation