Provider Demographics
NPI:1104024918
Name:BUI, KIM (OTR)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:BUI
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 1:1017 OLD VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-0399
Mailing Address - Country:US
Mailing Address - Phone:252-321-6001
Mailing Address - Fax:252-321-7008
Practice Address - Street 1:106 E VICTORIA CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5708
Practice Address - Country:US
Practice Address - Phone:252-321-6001
Practice Address - Fax:252-321-7008
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6364225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist