Individual
MISS HALEY KIMBALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
5871 HARBOUR VIEW BLVD, SUFFOLK, VA 23435-3669
(757) 819-5997
Mailing address
5204 HIWASSEE CIR, VIRGINIA BEACH, VA 23464-7984
(757) 348-2504
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131-001814
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0131001814
COTA LICENSE
VA
Enumeration date
07/20/2017
Last updated
03/17/2018
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