Provider Demographics
NPI:1821214248
Name:DITTO, KIMBERLY JENEE (OTR)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JENEE
Last Name:DITTO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14130 MESA RD
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-6318
Mailing Address - Country:US
Mailing Address - Phone:805-462-1244
Mailing Address - Fax:805-461-5138
Practice Address - Street 1:14130 MESA ROAD
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-6318
Practice Address - Country:US
Practice Address - Phone:805-462-1244
Practice Address - Fax:805-461-5138
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA995914225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist