Provider Demographics
NPI:1124147160
Name:HILL, KIMBERLY HAVENS (COTA)
Entity type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:HAVENS
Last Name:HILL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 E 95TH ST
Mailing Address - Street 2:APARTMENT 11 L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-4012
Mailing Address - Country:US
Mailing Address - Phone:212-706-7303
Mailing Address - Fax:
Practice Address - Street 1:235 E 95TH ST
Practice Address - Street 2:APARTMENT 11 L
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-4012
Practice Address - Country:US
Practice Address - Phone:212-706-7303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY64 004513224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant