Provider Demographics
NPI:1396999348
Name:KIM, KRISTINA (OTR/L)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7206 BRIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:BEN AVON
Mailing Address - State:PA
Mailing Address - Zip Code:15202-1903
Mailing Address - Country:US
Mailing Address - Phone:412-734-4675
Mailing Address - Fax:
Practice Address - Street 1:7206 BRIGHTON ROAD
Practice Address - Street 2:
Practice Address - City:BEN AVON
Practice Address - State:PA
Practice Address - Zip Code:15202
Practice Address - Country:US
Practice Address - Phone:412-734-4675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006906L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOC006906LOtherOT LISCENSURE