Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 46TR00533600 | NJ |
NPI | 1255702866 |
---|---|
Provider Name | Kimberly Estrada |
First Address | Bergenfield, NJ 07621-1922 |
Second Address | Bergenfield, NJ 07621-1922 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2015 |
Last Update Date | 08/11/2017 |