Provider Demographics
NPI:1538483847
Name:SERVAIS, KIMBERLY JEAN (OTR)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JEAN
Last Name:SERVAIS
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 1:106 S HOLMEN DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HOLMEN
Mailing Address - State:WI
Mailing Address - Zip Code:54636-9467
Mailing Address - Country:US
Mailing Address - Phone:608-989-2195
Mailing Address - Fax:
Practice Address - Street 1:106 S HOLMEN DR
Practice Address - Street 2:SUITE 2
Practice Address - City:HOLMEN
Practice Address - State:WI
Practice Address - Zip Code:54636-9467
Practice Address - Country:US
Practice Address - Phone:608-989-2195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4851-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist