Provider Demographics
NPI:1134506876
Name:GODWIN, KIMBERLY ANITA (OT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANITA
Last Name:GODWIN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
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Mailing Address - Street 1:101 MANNING DRIVE
Mailing Address - Street 2:DEPARTMENT OF PT/OT
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-4220
Mailing Address - Country:US
Mailing Address - Phone:984-974-0032
Mailing Address - Fax:984-974-4950
Practice Address - Street 1:111 SUNNYBROOK ROAD
Practice Address - Street 2:UNC HOSPITALS AT WAKEBROOK
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610
Practice Address - Country:US
Practice Address - Phone:984-974-0032
Practice Address - Fax:984-974-4950
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9702225X00000X, 225XM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist