Provider Demographics
NPI:1225371123
Name:ADLER, KIMBERLY FAITH (MOT OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:FAITH
Last Name:ADLER
Suffix:
Gender:F
Credentials:MOT OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 VIA CALLEJON
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6213
Mailing Address - Country:US
Mailing Address - Phone:949-498-5100
Mailing Address - Fax:
Practice Address - Street 1:1120 VIA CALLEJON
Practice Address - Street 2:SUITE B
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6213
Practice Address - Country:US
Practice Address - Phone:949-498-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13311225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist