Provider Demographics
NPI:1679385298
Name:JAMISON, KIMYIA
Entity type:Individual
Prefix:
First Name:KIMYIA
Middle Name:
Last Name:JAMISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12428 W THUNDERBIRD RD
Mailing Address - Street 2:
Mailing Address - City:EL MIRAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85335-3113
Mailing Address - Country:US
Mailing Address - Phone:623-399-6159
Mailing Address - Fax:623-399-6416
Practice Address - Street 1:12428 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:EL MIRAGE
Practice Address - State:AZ
Practice Address - Zip Code:85335-3113
Practice Address - Country:US
Practice Address - Phone:623-399-6159
Practice Address - Fax:623-399-6416
Is Sole Proprietor?:No
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist