Provider Demographics
NPI:1447373808
Name:ANDERSON, KIMBERLY N (MS, OTRL)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:N
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 PRINDLE CT
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-4829
Mailing Address - Country:US
Mailing Address - Phone:410-207-8906
Mailing Address - Fax:
Practice Address - Street 1:413 PRINDLE CT
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-4829
Practice Address - Country:US
Practice Address - Phone:410-207-8906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04704225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD419800000Medicaid