Provider Demographics
NPI:1073251773
Name:BOS-JANIAK, KIMBERLY S (COTA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:BOS-JANIAK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11938 W 108TH PL APT SUITE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-8403
Mailing Address - Country:US
Mailing Address - Phone:219-680-9705
Mailing Address - Fax:
Practice Address - Street 1:11938 W 108TH PL
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-8403
Practice Address - Country:US
Practice Address - Phone:219-680-9705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant