Provider Demographics
NPI:1871185074
Name:NOVAK, KIMBERLY GRACE (OTR)
Entity type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:GRACE
Last Name:NOVAK
Suffix:
Gender:F
Credentials:OTR
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Mailing Address - Street 1:8101 BOAT CLUB RD STE 330
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-3633
Mailing Address - Country:US
Mailing Address - Phone:682-498-3928
Mailing Address - Fax:214-935-2457
Practice Address - Street 1:833 TOWNE CT
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76179-1280
Practice Address - Country:US
Practice Address - Phone:214-302-9725
Practice Address - Fax:214-935-2457
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX121564225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist