Provider Demographics
NPI:1710376959
Name:FIORELLA, KIMBERLY LYNNE (OTA)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:LYNNE
Last Name:FIORELLA
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:RUNNEMEDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08078-1449
Mailing Address - Country:US
Mailing Address - Phone:856-685-3639
Mailing Address - Fax:
Practice Address - Street 1:3001 E EVESHAM RD
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9547
Practice Address - Country:US
Practice Address - Phone:856-751-1548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TAO9102700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist