Provider Demographics
NPI:1689872996
Name:ZEIDENSTEIN, KIMBERLY DIANNE (MHA, OTR L)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DIANNE
Last Name:ZEIDENSTEIN
Suffix:
Gender:F
Credentials:MHA, OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7394 E HUNTINGTON DR
Mailing Address - Street 2:UNIT A
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-8034
Mailing Address - Country:US
Mailing Address - Phone:330-726-5475
Mailing Address - Fax:330-726-7895
Practice Address - Street 1:4780 KIRK RD
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-5403
Practice Address - Country:US
Practice Address - Phone:330-792-7681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH000979225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist