Provider Demographics
NPI:1720238165
Name:KIRKLAND, AVA DANIELLE (OTR)
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:DANIELLE
Last Name:KIRKLAND
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:AVA
Other - Middle Name:DANIELLE
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:2222 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7958
Mailing Address - Country:US
Mailing Address - Phone:800-944-9782
Mailing Address - Fax:610-438-2024
Practice Address - Street 1:2002 ANDREW AVE
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-6563
Practice Address - Country:US
Practice Address - Phone:219-325-1599
Practice Address - Fax:219-362-1682
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003447A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist