Provider Demographics
NPI:1861155517
Name:BURNS, KIMBERLY MCKENNA (COTA/L)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MCKENNA
Last Name:BURNS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:MCKENNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3906 KRISTA LN
Mailing Address - Street 2:
Mailing Address - City:HAYES
Mailing Address - State:VA
Mailing Address - Zip Code:23072-2714
Mailing Address - Country:US
Mailing Address - Phone:856-981-5105
Mailing Address - Fax:
Practice Address - Street 1:3906 KRISTA LN
Practice Address - Street 2:
Practice Address - City:HAYES
Practice Address - State:VA
Practice Address - Zip Code:23072-2714
Practice Address - Country:US
Practice Address - Phone:856-981-5105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP009663224Z00000X
NJ46TA09179200224Z00000X
VA0131002523224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant