Provider Demographics
NPI:1659670792
Name:KIMMONS, ATARAH RANIT (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ATARAH
Middle Name:RANIT
Last Name:KIMMONS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ATARAH
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3514 BURKE ROAD SUITE 500
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504
Mailing Address - Country:US
Mailing Address - Phone:305-772-8238
Mailing Address - Fax:
Practice Address - Street 1:3514 BURKE RD STE 500
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-2302
Practice Address - Country:US
Practice Address - Phone:281-761-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114103225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist