Provider Demographics
NPI:1669627220
Name:HERMANS, KIM GRACE (OTR)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:GRACE
Last Name:HERMANS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:GRACE
Other - Last Name:WESTPHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2320 LADYBIRD DR
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-5697
Mailing Address - Country:US
Mailing Address - Phone:920-574-2257
Mailing Address - Fax:
Practice Address - Street 1:130 2ND ST
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2883
Practice Address - Country:US
Practice Address - Phone:920-729-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2321-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist