Provider Demographics
NPI:1336680735
Name:NIGHTENGALE, KIRSTIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:KIRSTIE
Middle Name:
Last Name:NIGHTENGALE
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 1:15 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:LONACONING
Mailing Address - State:MD
Mailing Address - Zip Code:21539-1021
Mailing Address - Country:US
Mailing Address - Phone:240-362-4644
Mailing Address - Fax:
Practice Address - Street 1:2720 CHARLES TOWN RD
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25405-5626
Practice Address - Country:US
Practice Address - Phone:304-263-0933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVC2135224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant