Basic Information
| Provider Information | |||||||||
| NPI: | 1821705989 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEWEY | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | STEWART | ||||||||
| OtherFirstName: | KIMBERLY | ||||||||
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| OtherCredential: | MSOTR | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10517 BARTLEY DR | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462368377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175562797 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8400 CLEARVISTA PL | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462563700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178450464 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2022 | ||||||||
| LastUpdateDate: | 10/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 31003680A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 31003680A | 01 | IN | OT LICENSE | OTHER |