Provider Demographics
NPI:1083798383
Name:WEIR, KIMBERLY A (OTR/L)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:WEIR
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LAUREL WAY
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-1266
Mailing Address - Country:US
Mailing Address - Phone:509-869-1485
Mailing Address - Fax:610-270-0374
Practice Address - Street 1:120 W GERMANTOWN PIKE STE 100
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1420
Practice Address - Country:US
Practice Address - Phone:610-270-0370
Practice Address - Fax:610-270-0374
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00004029225XH1200X
PAOC013204225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0214773OtherDEPARTMENT OF LABOR AND INDUSTRIES
WA8466393Medicaid
WACN2416OtherRAILROAD MEDICARE
WA0214773OtherDEPARTMENT OF LABOR AND INDUSTRIES
WACN2416OtherRAILROAD MEDICARE