Individual
KIMBERLY ANN DRAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
325 ALEXANDER ST, FAYETTEVILLE, NC 28301-5752
(910) 920-1068
Mailing address
816 FAIRFIELD CIR, RAEFORD, NC 28376-6722
(419) 575-7961
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
7977
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1413735J65F1
—
NC
Enumeration date
08/08/2011
Last updated
04/03/2013
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