Provider Demographics
NPI:1972960946
Name:CARDUCCI, KIMBERLY (COTA/L)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CARDUCCI
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7211 GITHENS AVE
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-3156
Mailing Address - Country:US
Mailing Address - Phone:856-486-2055
Mailing Address - Fax:
Practice Address - Street 1:7211 GITHENS AVE
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08109-3156
Practice Address - Country:US
Practice Address - Phone:856-486-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09114700224Z00000X
PAOP008327224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant