Provider Demographics
NPI:1609161991
Name:ADAMS, KIMBERLY MICHELLE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MICHELLE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:1002 STEEPLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8041
Mailing Address - Country:US
Mailing Address - Phone:803-271-2364
Mailing Address - Fax:803-708-5618
Practice Address - Street 1:1002 STEEPLE RIDGE RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-8041
Practice Address - Country:US
Practice Address - Phone:803-271-2364
Practice Address - Fax:803-708-5618
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3604225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist