Individual
KIMBERLY VANDENWYMELENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, OTR L
Contact information
Practice address
890 N COLE RD, SUITE A, BOISE, ID 83704-8638
(208) 323-8888
(208) 323-8889
Mailing address
5900 LUBKIN ST, BOISE, ID 83704-7558
(208) 322-3347
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-758
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W1225
BLUE CROSS INSURANCE
ID
Enumeration date
01/31/2007
Last updated
07/08/2007
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