Provider Demographics
NPI:1447856927
Name:KLEIN, KIMBERLY D
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:D
Last Name:KLEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:D
Other - Last Name:WYLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:765 H ST
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-5121
Mailing Address - Country:US
Mailing Address - Phone:360-332-0722
Mailing Address - Fax:360-332-0555
Practice Address - Street 1:765 H ST
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:WA
Practice Address - Zip Code:98230-5121
Practice Address - Country:US
Practice Address - Phone:360-332-0722
Practice Address - Fax:360-332-0555
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00000837224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant