Provider Demographics
NPI:1326468646
Name:MCINNIS, KIMBERLY COVELL (OTD, MS, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:COVELL
Last Name:MCINNIS
Suffix:
Gender:F
Credentials:OTD, MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5649 MEADOWCREST ST
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-4833
Mailing Address - Country:US
Mailing Address - Phone:540-556-2344
Mailing Address - Fax:
Practice Address - Street 1:5649 MEADOWCREST ST
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-4833
Practice Address - Country:US
Practice Address - Phone:540-556-2344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000248174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist