Individual
KIMBERLY SUE CONVERSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
2927 LAKE AVE, FORT WAYNE, IN 46805-5415
(260) 452-9985
Mailing address
9515 CARINE CV, FORT WAYNE, IN 46835-9371
(260) 348-0270
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31000770A
IN
Other
Enumeration date
02/02/2021
Last updated
02/02/2021
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