Provider Demographics
NPI:1417439134
Name:KOHL, KIMBERLY ANN (MAOL, OTR/L)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:KOHL
Suffix:
Gender:F
Credentials:MAOL, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BAKER BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3635
Mailing Address - Country:US
Mailing Address - Phone:330-801-4308
Mailing Address - Fax:330-319-8545
Practice Address - Street 1:50 BAKER BLVD STE 4
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3635
Practice Address - Country:US
Practice Address - Phone:330-801-4308
Practice Address - Fax:330-319-8545
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02755225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist