Provider Demographics
NPI:1407145196
Name:WARNER, KIMBERLY ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:WARNER
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 1:3990 BRICK SCHOOLHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:HAMLIN
Mailing Address - State:NY
Mailing Address - Zip Code:14464-9549
Mailing Address - Country:US
Mailing Address - Phone:585-301-3688
Mailing Address - Fax:
Practice Address - Street 1:3990 BRICK SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:HAMLIN
Practice Address - State:NY
Practice Address - Zip Code:14464-9549
Practice Address - Country:US
Practice Address - Phone:585-301-3688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63016649225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist