Provider Demographics
NPI:1326262015
Name:PACKWOOD-NAVARRO, KIMBERLY LYN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LYN
Last Name:PACKWOOD-NAVARRO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7411 W 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7482
Mailing Address - Country:US
Mailing Address - Phone:219-558-8158
Mailing Address - Fax:
Practice Address - Street 1:901 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321
Practice Address - Country:US
Practice Address - Phone:219-836-4527
Practice Address - Fax:219-836-6752
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32000252A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant