Provider Demographics
NPI:1548647746
Name:KIMURA, JHONAVIE MG (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:JHONAVIE
Middle Name:MG
Last Name:KIMURA
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4733 SW GREENSBORO WAY
Mailing Address - Street 2:APT 100
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97078-7873
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2274 SW 2ND ST STE D
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-5597
Practice Address - Country:US
Practice Address - Phone:503-263-8903
Practice Address - Fax:503-266-8632
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR341265225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist