Provider Demographics
NPI:1376817783
Name:KIMBERLING, LAURA CLARE (OTR)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:CLARE
Last Name:KIMBERLING
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:PO BOX 84
Mailing Address - Street 2:
Mailing Address - City:SLEETMUTE
Mailing Address - State:AK
Mailing Address - Zip Code:99668-0084
Mailing Address - Country:US
Mailing Address - Phone:907-449-4216
Mailing Address - Fax:907-449-4217
Practice Address - Street 1:4015 LAKE OTIS PARKWAY
Practice Address - Street 2:#200
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-563-8318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK196225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist