Provider Demographics
NPI:1457766479
Name:FOREHAND, KIMBERLY HAUGEN (OTR)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:HAUGEN
Last Name:FOREHAND
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 1:2146 E ASH MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-9011
Mailing Address - Country:US
Mailing Address - Phone:513-532-5056
Mailing Address - Fax:
Practice Address - Street 1:2012 IRONWOOD CIR
Practice Address - Street 2:SUITE 230
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1888
Practice Address - Country:US
Practice Address - Phone:574-387-4049
Practice Address - Fax:574-387-4062
Is Sole Proprietor?:No
Enumeration Date:2014-06-28
Last Update Date:2014-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31005694A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist