Provider Demographics
NPI:1679679690
Name:SOLARI, KIMBERLY BENTLEY (OTR)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:BENTLEY
Last Name:SOLARI
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 1:3701 BURGOYNE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-2607
Mailing Address - Country:US
Mailing Address - Phone:337-477-7883
Mailing Address - Fax:337-477-7812
Practice Address - Street 1:3701 BURGOYNE DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-2607
Practice Address - Country:US
Practice Address - Phone:337-477-7883
Practice Address - Fax:337-477-7812
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z10492225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86728TOtherBCBS