Provider Demographics
NPI:1780942185
Name:DZURINKO, KIMBERLY A (OT)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:A
Last Name:DZURINKO
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 1:42 E MAIDEN ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-4912
Mailing Address - Country:US
Mailing Address - Phone:724-225-2228
Mailing Address - Fax:724-225-5746
Practice Address - Street 1:42 E MAIDEN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4912
Practice Address - Country:US
Practice Address - Phone:724-225-2228
Practice Address - Fax:724-225-5746
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008636174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOC008636OtherPA LICENSE
PAOC008636OtherPA LICENSE