Provider Demographics
NPI:1679687891
Name:MACDOUGALL, KIMBERLY A (OTR/L)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:MACDOUGALL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7720 US HIGHWAY 98 W
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-7230
Mailing Address - Country:US
Mailing Address - Phone:850-622-5192
Mailing Address - Fax:850-622-5196
Practice Address - Street 1:7720 US HIGHWAY 98 W
Practice Address - Street 2:SUITE 220
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-7230
Practice Address - Country:US
Practice Address - Phone:850-622-5192
Practice Address - Fax:850-622-5196
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14570225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist