Provider Demographics
NPI:1407974777
Name:LONSWAY, KIM E (OTR)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:E
Last Name:LONSWAY
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 1:8232 S PLACITA ALMERIA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-9026
Mailing Address - Country:US
Mailing Address - Phone:520-790-8896
Mailing Address - Fax:
Practice Address - Street 1:8232 S PLACITA ALMERIA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-9026
Practice Address - Country:US
Practice Address - Phone:520-790-8896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2572225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ595093Medicaid