Provider Demographics
NPI:1770621286
Name:KINMARTIN, MAUREEN SUE (OTR)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:SUE
Last Name:KINMARTIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13725 BIG TREE RD
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-9521
Mailing Address - Country:US
Mailing Address - Phone:716-805-1440
Mailing Address - Fax:716-805-1441
Practice Address - Street 1:960 WEST MAPLE COURT
Practice Address - Street 2:SUBURBAN ADULT SERVICES, INC.
Practice Address - City:ELMA
Practice Address - State:NY
Practice Address - Zip Code:14059
Practice Address - Country:US
Practice Address - Phone:716-805-1555
Practice Address - Fax:716-805-1444
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007054-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist