Provider Demographics
NPI:1700874203
Name:KOSCHINEG, KIMBERLY ANNE (OT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNE
Last Name:KOSCHINEG
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3761 BLACKBURN CT
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-3631
Mailing Address - Country:US
Mailing Address - Phone:215-750-0501
Mailing Address - Fax:215-750-0525
Practice Address - Street 1:3 CORNER STONE DRIVE
Practice Address - Street 2:SUITE 700
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:215-750-0501
Practice Address - Fax:215-340-1299
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008082225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7554721OtherAETNA - PPO
2727772000OtherIBC
1218373OtherAETNA - HMO
1747963OtherHIGHMARK BLUE SHIELD
203838157OtherUNITED
1747963OtherHIGHMARK BLUE SHIELD
091948VB4Medicare ID - Type Unspecified