Provider Demographics
NPI:1891962239
Name:BLY, KIMBERLY (COTA)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:BLY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 COLLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-5836
Mailing Address - Country:US
Mailing Address - Phone:919-460-6500
Mailing Address - Fax:
Practice Address - Street 1:711 COLLINGTON DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-5836
Practice Address - Country:US
Practice Address - Phone:919-460-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6472224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant