Individual
KIMBERLY NACOLE JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
435 PINE ST, FORT DEPOSIT, AL 36032-4740
(334) 833-2396
Mailing address
PO BOX 582, 435 PINE STREET, FORT DEPOSIT, AL 36032-0582
(334) 833-2396
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3721
AL
Other
Enumeration date
11/22/2015
Last updated
11/22/2015
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