Individual
MRS. KIMBERLY SUE VAN LOAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, OTR/L, CLT
Contact information
Practice address
3064 COVINGTON ST STE 104, RAPID CITY, SD 57703-7208
(605) 787-2719
(605) 718-4452
Mailing address
3064 COVINGTON ST STE 104, RAPID CITY, SD 57703-7208
(605) 787-2719
(605) 718-4452
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0704
SD
Other
Enumeration date
08/29/2009
Last updated
09/15/2014
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