Provider Demographics
NPI:1053071134
Name:WILLIAMS, KIMBERLY D
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 LARKSPUR DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-5432
Mailing Address - Country:US
Mailing Address - Phone:336-508-5439
Mailing Address - Fax:
Practice Address - Street 1:4822 TOWER RD UNIT C
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-5824
Practice Address - Country:US
Practice Address - Phone:336-283-5028
Practice Address - Fax:336-291-8784
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8444225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist