Provider Demographics
NPI:1396956314
Name:SANDERS, KIMBERLY ANN (OTRL)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:SANDERS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:SEITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:3850 FRUIT ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504-2022
Mailing Address - Country:US
Mailing Address - Phone:716-553-2504
Mailing Address - Fax:
Practice Address - Street 1:3850 FRUIT ST
Practice Address - Street 2:155 W 8TH ST
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-2022
Practice Address - Country:US
Practice Address - Phone:814-451-8412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009928225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics