Provider Demographics
NPI:1447480363
Name:WANG, KIMBERLY HSIN- WEI (COTA/L)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:HSIN- WEI
Last Name:WANG
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 THORPE AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-8309
Mailing Address - Country:US
Mailing Address - Phone:203-634-0780
Mailing Address - Fax:203-634-1708
Practice Address - Street 1:292 THORPE AVE
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-8309
Practice Address - Country:US
Practice Address - Phone:203-634-0780
Practice Address - Fax:203-634-1708
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001114224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant