Provider Demographics
NPI:1972601698
Name:GARGIN, KIMBERLY A (OTR)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:GARGIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:NEWMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:3 COOPER PLZ
Mailing Address - Street 2:SUITE 518
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1438
Mailing Address - Country:US
Mailing Address - Phone:856-968-7494
Mailing Address - Fax:
Practice Address - Street 1:3 COOPER PLZ
Practice Address - Street 2:SUITE 518
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-968-7494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTR002968225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1362797OtherAETNA
NJ7949106OtherCIGNA
NJ2142740000OtherAMERIHEALTH/KEYSTON/IBC
NJ2767103OtherUNITED HEALTHCARE
NJ7949106OtherCIGNA