Provider Demographics
NPI:1699368068
Name:CAMPMAN, KIMBERLY NICOLE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:NICOLE
Last Name:CAMPMAN
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 1:2548 STERN DR S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32233-2917
Mailing Address - Country:US
Mailing Address - Phone:904-699-6388
Mailing Address - Fax:
Practice Address - Street 1:1381 COUNTRY RD 3520
Practice Address - Street 2:
Practice Address - City:HAWKINS
Practice Address - State:TN
Practice Address - Zip Code:75765
Practice Address - Country:US
Practice Address - Phone:904-699-6388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121501225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist