Provider Demographics
NPI:1801517560
Name:EVERETT-EATON, KIMBERLY NICOLE (OTD, OTR/L)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:NICOLE
Last Name:EVERETT-EATON
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 TUCKER RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95076-9281
Mailing Address - Country:US
Mailing Address - Phone:831-206-8624
Mailing Address - Fax:
Practice Address - Street 1:2 UPPER RAGSDALE DR UNIT A
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5736
Practice Address - Country:US
Practice Address - Phone:831-642-6201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23914225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist