Provider Demographics
NPI:1659402402
Name:FLETCHER, KIM KLINGENMAIER (MS, OTR)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:KLINGENMAIER
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:MS
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:KLINGENMAIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR
Mailing Address - Street 1:788 ROLLING VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-4655
Mailing Address - Country:US
Mailing Address - Phone:443-994-1252
Mailing Address - Fax:
Practice Address - Street 1:2644 RIVA RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7427
Practice Address - Country:US
Practice Address - Phone:410-222-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03434225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5094Medicaid