Basic Information
| Provider Information | |||||||||
| NPI: | 1205805348 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARKWELL | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1210 GEMINI PLACE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432406110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142620907 | ||||||||
| FaxNumber: | 6142625269 | ||||||||
| Practice Location | |||||||||
| Address1: | 1210 GEMINI PLACE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432406110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142620907 | ||||||||
| FaxNumber: | 6142625269 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 03/29/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT-02544 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | OT-02544 | 01 | OH | OT LICENSE | OTHER |