Provider Demographics
NPI:1740682509
Name:ENRIQUEZ, KIMBERLY ANNE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANNE
Last Name:ENRIQUEZ
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 1:38416 N 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:DESERT HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-9125
Mailing Address - Country:US
Mailing Address - Phone:623-326-4302
Mailing Address - Fax:
Practice Address - Street 1:38416 N 29TH AVE
Practice Address - Street 2:
Practice Address - City:DESERT HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85086-9125
Practice Address - Country:US
Practice Address - Phone:623-326-4302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ1380225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist