Provider Demographics
NPI:1700865318
Name:KIDWELL, PATRICIA J (OTR/L)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:KIDWELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:PATTY
Other - Middle Name:JO
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:148 RICE ML
Mailing Address - Street 2:
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-5416
Mailing Address - Country:US
Mailing Address - Phone:912-638-7174
Mailing Address - Fax:
Practice Address - Street 1:2415 PARKWOOD DR
Practice Address - Street 2:O.P. REHABILITATION
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4722
Practice Address - Country:US
Practice Address - Phone:912-466-5362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001950225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist