Provider Demographics
NPI:1255702866
Name:ESTRADA, KIMBERLY (OTR/L)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:PINGUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:37 REID AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-1922
Mailing Address - Country:US
Mailing Address - Phone:201-638-2930
Mailing Address - Fax:
Practice Address - Street 1:37 REID AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-1922
Practice Address - Country:US
Practice Address - Phone:201-638-2930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00533600225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation