Provider Demographics
NPI:1144557075
Name:KIMBLE, SHEILA SUE (COTA)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:SUE
Last Name:KIMBLE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 EDWIN ST.
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-3895
Mailing Address - Country:US
Mailing Address - Phone:734-326-9322
Mailing Address - Fax:
Practice Address - Street 1:1451 EDWIN ST
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-3895
Practice Address - Country:US
Practice Address - Phone:734-326-9322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202004917224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant