Provider Demographics
NPI:1194850511
Name:BARBERA, KIMBERLY (MS, OTR L)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BARBERA
Suffix:
Gender:F
Credentials:MS, OTR L
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:MICHAELSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR L
Mailing Address - Street 1:30 JEFFERSON LANDING CIR
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1989
Mailing Address - Country:US
Mailing Address - Phone:631-828-6789
Mailing Address - Fax:
Practice Address - Street 1:30 JEFFERSON LANDING CIR
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1989
Practice Address - Country:US
Practice Address - Phone:631-828-6789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009670225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics