Provider Demographics
NPI:1669991980
Name:MARTIN, KIMBERLY SHIRELLE (COTA/L)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SHIRELLE
Last Name:MARTIN
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 1:8317 EDGEDALE RD
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-5011
Mailing Address - Country:US
Mailing Address - Phone:443-882-1890
Mailing Address - Fax:
Practice Address - Street 1:9200 FRANKLIN SQUARE DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4458
Practice Address - Country:US
Practice Address - Phone:410-391-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant