Provider Demographics
NPI:1508369885
Name:CHAMBERS, KIMBERLY ELIZABETH (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ELIZABETH
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:ELIZABETH
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10128 COOK AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3834
Mailing Address - Country:US
Mailing Address - Phone:812-361-3881
Mailing Address - Fax:
Practice Address - Street 1:1595 S CALUMET RD STE 3
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-2389
Practice Address - Country:US
Practice Address - Phone:219-764-4888
Practice Address - Fax:219-898-4258
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31006565A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200196020AMedicaid