Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OC007089L | PA |
NPI | 1144283755 |
---|---|
Provider Name | Kimberly Kivlan |
First Address | Wexford, PA 15090-7380 |
Second Address | Wexford, PA 15090-7380 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1620295 | BLUE CROSS/BLUE SHIELD (01) | PA |
Q19360 | (02) | PA |