Provider Demographics
NPI:1134441793
Name:KEMERY, KIM (COTA)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:KEMERY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 MAIN DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-5278
Mailing Address - Country:US
Mailing Address - Phone:479-856-6400
Mailing Address - Fax:479-856-6623
Practice Address - Street 1:2603 MAIN DR
Practice Address - Street 2:SUITE 3
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-5278
Practice Address - Country:US
Practice Address - Phone:479-856-6400
Practice Address - Fax:479-856-6623
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant