Provider Demographics
NPI:1326259516
Name:ELDER, KIMBERLY (OTR)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:ELDER
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 1:9128 FOREST RD
Mailing Address - Street 2:
Mailing Address - City:WHITMORE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48189-9526
Mailing Address - Country:US
Mailing Address - Phone:734-883-7575
Mailing Address - Fax:
Practice Address - Street 1:2636 S MILFORD RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:MI
Practice Address - Zip Code:48357-4938
Practice Address - Country:US
Practice Address - Phone:248-684-9610
Practice Address - Fax:248-684-9611
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006021225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics