Provider Demographics
NPI:1629299409
Name:CALLENDER, KIMBERLY D (OTR)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:D
Last Name:CALLENDER
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:PO BOX 503
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:90743-0503
Mailing Address - Country:US
Mailing Address - Phone:714-345-9556
Mailing Address - Fax:
Practice Address - Street 1:3 B SURFSIDE AVE.
Practice Address - Street 2:
Practice Address - City:SURFSIDE
Practice Address - State:CA
Practice Address - Zip Code:90743
Practice Address - Country:US
Practice Address - Phone:714-345-9556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT6016225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist