Provider Demographics
NPI:1245238963
Name:KIMBLE, CHRISTINE ANN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ANN
Last Name:KIMBLE
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 1:34 SENTINEL TRL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-5413
Mailing Address - Country:US
Mailing Address - Phone:954-588-8210
Mailing Address - Fax:
Practice Address - Street 1:34 SENTINEL TRL
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-5413
Practice Address - Country:US
Practice Address - Phone:954-588-8210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11304225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics