Provider Demographics
NPI:1376325209
Name:KIMURA, ALLISON LEE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:LEE
Last Name:KIMURA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 FOERSTER ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-1343
Mailing Address - Country:US
Mailing Address - Phone:415-601-1699
Mailing Address - Fax:
Practice Address - Street 1:306 FOERSTER ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-1343
Practice Address - Country:US
Practice Address - Phone:415-601-1699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19437225X00000X
CO0008162225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist