Provider Demographics
NPI:1558935957
Name:HEWITT, KIMBERLY BELLE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:BELLE
Last Name:HEWITT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:HEWITT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:248 RIBBON LEAF VW
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-3943
Mailing Address - Country:US
Mailing Address - Phone:770-312-9720
Mailing Address - Fax:
Practice Address - Street 1:6340 SUGARLOAF PKWY STE 125
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4331
Practice Address - Country:US
Practice Address - Phone:770-476-5877
Practice Address - Fax:770-476-5835
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT000610225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist