Provider Demographics
NPI:1336504539
Name:KIMBALL, APRIL
Entity Type:Individual
Prefix:MS
First Name:APRIL
Middle Name:
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:APRIL
Other - Middle Name:R
Other - Last Name:KIMBALL-ROSANSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:150 VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1238
Mailing Address - Country:US
Mailing Address - Phone:315-331-7741
Mailing Address - Fax:315-331-0566
Practice Address - Street 1:150 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1238
Practice Address - Country:US
Practice Address - Phone:315-331-7741
Practice Address - Fax:315-331-0566
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000749-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant