Provider Demographics
NPI:1003475245
Name:EASTON, KIMBERLY (OTD OT/L)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:EASTON
Suffix:
Gender:F
Credentials:OTD OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 10TH ST APT 310
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-2974
Mailing Address - Country:US
Mailing Address - Phone:310-650-3637
Mailing Address - Fax:
Practice Address - Street 1:901 10TH ST APT 310
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-2974
Practice Address - Country:US
Practice Address - Phone:310-650-3637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4523225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist