Provider Demographics
NPI:1851619530
Name:ROSELAND, KIMBERLY (OTR/L)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:ROSELAND
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 1:181 CIMARRON PARK LOOP
Mailing Address - Street 2:SUITE D
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-2852
Mailing Address - Country:US
Mailing Address - Phone:512-295-2273
Mailing Address - Fax:512-295-2280
Practice Address - Street 1:181 CIMARRON PARK LOOP
Practice Address - Street 2:SUITE D
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-2852
Practice Address - Country:US
Practice Address - Phone:512-295-2273
Practice Address - Fax:512-295-2280
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10382225X00000X
TX113786225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist