Provider Demographics
NPI:1295993806
Name:WILLIAMS, KIMBERLY RAE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:RAE
Last Name:WILLIAMS
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 1:1010 CAMPGROUND RD
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-3908
Mailing Address - Country:US
Mailing Address - Phone:501-454-9227
Mailing Address - Fax:
Practice Address - Street 1:1010 CAMPGROUND ROAD
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-3908
Practice Address - Country:US
Practice Address - Phone:501-454-9227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR386225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist