Provider Demographics
NPI:1740770122
Name:FERRELL, KIMBERLY DIANE (OY)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DIANE
Last Name:FERRELL
Suffix:
Gender:F
Credentials:OY
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:DIANE
Other - Last Name:LINNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:1954 ROCKLEDGE BLVD STE 119
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3761
Mailing Address - Country:US
Mailing Address - Phone:321-433-1556
Mailing Address - Fax:321-433-1500
Practice Address - Street 1:689 S APOLLO BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1455
Practice Address - Country:US
Practice Address - Phone:321-674-5035
Practice Address - Fax:321-674-5039
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT17959225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist