Provider Demographics
NPI:1649600271
Name:BRIMLOW, KIMBERLY LOUISE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:LOUISE
Last Name:BRIMLOW
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4085 E VENICE AVE LOT 92
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-2520
Mailing Address - Country:US
Mailing Address - Phone:863-514-5876
Mailing Address - Fax:
Practice Address - Street 1:4085 E VENICE AVE LOT 92
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-2520
Practice Address - Country:US
Practice Address - Phone:863-514-5876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA13281224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant