Provider Demographics
NPI:1770760191
Name:DUGAS, KIMBERLY ERIKA (OTR/L)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ERIKA
Last Name:DUGAS
Suffix:
Gender:F
Credentials: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:PO BOX 74325
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-4325
Mailing Address - Country:US
Mailing Address - Phone:253-691-7984
Mailing Address - Fax:
Practice Address - Street 1:3411 LATHROP ST STE A
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7462
Practice Address - Country:US
Practice Address - Phone:253-691-7984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1896225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics