Provider Demographics
NPI:1407459068
Name:KIMBALL, MELISSA ELIZABETH (DROT, OTR/L)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ELIZABETH
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:DROT, OTR/L
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ELIZABETH
Other - Last Name:NORMANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:872 N BAILEY ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-1807
Mailing Address - Country:US
Mailing Address - Phone:609-703-4795
Mailing Address - Fax:
Practice Address - Street 1:EBS CHILDREN'S INSTITUTE OF PHILADELPHIA
Practice Address - Street 2:1500 S. CHRISTOPHER COLUMBUS BLVD., FLOOR 2
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147
Practice Address - Country:US
Practice Address - Phone:215-918-9310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC016374225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist