Provider Demographics
NPI:1922387372
Name:JAMES, KEVIN OTIS (LPTA)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:OTIS
Last Name:JAMES
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 W PARK AVE # 117
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-7205
Mailing Address - Country:US
Mailing Address - Phone:848-207-1643
Mailing Address - Fax:
Practice Address - Street 1:823 W PARK AVE # 117
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-7205
Practice Address - Country:US
Practice Address - Phone:848-207-1643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00271000225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant