Provider Demographics
NPI:1093068793
Name:WHITE, KIMBERLY HARWOOD (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:HARWOOD
Last Name:WHITE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:JEAN
Other - Last Name:HARWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2311 QUEENSBURY DR
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2929
Mailing Address - Country:US
Mailing Address - Phone:410-877-9692
Mailing Address - Fax:
Practice Address - Street 1:138 INDUSTRY LN
Practice Address - Street 2:UNIT 5A
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-1741
Practice Address - Country:US
Practice Address - Phone:443-752-1617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01809225XP0200X, 225XR0403X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community Mobility