Provider Demographics
NPI:1467108381
Name:KIMMEL, KAREN ELIZABETH (COTA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ELIZABETH
Last Name:KIMMEL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ELIZABETH
Other - Last Name:KIMMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HARTBARGER
Mailing Address - Street 1:10886 N US HIGHWAY 231
Mailing Address - Street 2:
Mailing Address - City:ROACHDALE
Mailing Address - State:IN
Mailing Address - Zip Code:46172-9139
Mailing Address - Country:US
Mailing Address - Phone:260-909-0871
Mailing Address - Fax:
Practice Address - Street 1:10886 N US HIGHWAY 231
Practice Address - Street 2:
Practice Address - City:ROACHDALE
Practice Address - State:IN
Practice Address - Zip Code:46172-9139
Practice Address - Country:US
Practice Address - Phone:260-909-0871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001800A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant