Provider Demographics
NPI:1508059460
Name:BARRETT, KIMBERLY AR (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:AR
Last Name:BARRETT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:REXIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 HEATHROW DR
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-9322
Mailing Address - Country:US
Mailing Address - Phone:248-259-3317
Mailing Address - Fax:
Practice Address - Street 1:4602 CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-2412
Practice Address - Country:US
Practice Address - Phone:910-423-5622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112368225XP0200X
KYR4259225XP0200X
NC8543225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics