Provider Demographics
NPI:1992288500
Name:WELIKADAGE, KIMBERLY WS (OTR/L)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:WS
Last Name:WELIKADAGE
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 1:4518 BENNOCH RD
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:ME
Mailing Address - Zip Code:04468-4017
Mailing Address - Country:US
Mailing Address - Phone:207-939-6150
Mailing Address - Fax:
Practice Address - Street 1:36 WORKMAN TER
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-1162
Practice Address - Country:US
Practice Address - Phone:207-794-6534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT2627225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist