Provider Demographics
NPI:1144338427
Name:KIMES, EDWARD (OTR)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:KIMES
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 COUNTY ROAD 400
Mailing Address - Street 2:
Mailing Address - City:YOAKUM
Mailing Address - State:TX
Mailing Address - Zip Code:77995-6636
Mailing Address - Country:US
Mailing Address - Phone:361-293-3471
Mailing Address - Fax:
Practice Address - Street 1:115 MEDICAL DR STE 207
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-3106
Practice Address - Country:US
Practice Address - Phone:361-572-4246
Practice Address - Fax:361-572-9490
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105776225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist