Provider Demographics
NPI:1588838270
Name:LAMPE, KIMBERLY JO (OTR)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JO
Last Name:LAMPE
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 1:1151 S MAIN ST
Mailing Address - Street 2:APT #303
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-9646
Mailing Address - Country:US
Mailing Address - Phone:919-556-1336
Mailing Address - Fax:
Practice Address - Street 1:1151 S MAIN ST
Practice Address - Street 2:APT #303
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-9646
Practice Address - Country:US
Practice Address - Phone:919-556-1336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3260026225X00000X
NC10429225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40812300Medicaid