Provider Demographics
NPI:1215790613
Name:CALZADO, KIBWE (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:KIBWE
Middle Name:
Last Name:CALZADO
Suffix:
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 N BROADWAY APT B
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-1603
Mailing Address - Country:US
Mailing Address - Phone:609-789-6961
Mailing Address - Fax:
Practice Address - Street 1:82 BETHANY RD STE 1
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1459
Practice Address - Country:US
Practice Address - Phone:732-888-3912
Practice Address - Fax:732-888-2916
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01113400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist