Provider Demographics
NPI:1831140219
Name:EDWARDS, KIMBERLY A (OTRL)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7773 N JOHN HANCOCK AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-1554
Mailing Address - Country:US
Mailing Address - Phone:520-241-7194
Mailing Address - Fax:
Practice Address - Street 1:2303 N SWAN RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2716
Practice Address - Country:US
Practice Address - Phone:520-241-7194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2383174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist