Provider Demographics
NPI:1134158777
Name:KIMPS, CARLA (OTR LCHT)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:KIMPS
Suffix:
Gender:F
Credentials:OTR LCHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6393 PUTNAM ST
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-7661
Mailing Address - Country:US
Mailing Address - Phone:904-829-9494
Mailing Address - Fax:904-829-9334
Practice Address - Street 1:1 ORTHOPAEDIC PL
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4202
Practice Address - Country:US
Practice Address - Phone:904-825-0540
Practice Address - Fax:904-825-0351
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT7442225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1174540001OtherDMERC CIGNA GOVT SVCS