Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 0119000086 | VA |
Y | 225XH1200X | Occupational Therapist - Hand | 0119000086 | VA |
NPI | 1265654388 |
---|---|
Provider Name | Mrs. Kimberly Simora Pisk |
First Address | Harrisonburg, VA 22801-7622 |
Second Address | Harrisonburg, VA 22801-7622 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 23/06/2015 |