Individual
KIMBERLY HUMPHREY BRAILSFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
208 MERCER ROAD, ELIZABETHTOWN, NC 28337
(910) 862-8181
Mailing address
155 HORSESHOE LN, BURGAW, NC 28425-8229
(910) 352-9054
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
390720
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09170607461
AHA BLS
NC
01
—
11366
NCBOT
NC
01
—
390720
NBCOT
—
Enumeration date
05/25/2018
Last updated
05/25/2018
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