Provider Demographics
NPI:1144500216
Name:TALMAGE, KIMBERLY SUSAN (OTR)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUSAN
Last Name:TALMAGE
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 1:303 BALCH ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-2706
Mailing Address - Country:US
Mailing Address - Phone:269-343-7100
Mailing Address - Fax:269-349-4004
Practice Address - Street 1:303 BALCH ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-2706
Practice Address - Country:US
Practice Address - Phone:269-343-7100
Practice Address - Fax:269-349-4004
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201002006225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist