MEDICARE: KIMBERLY MARIE FOLTZ OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist
2	225X00000X	Occupational Therapist	022915	NY

General Provider Information

NPI Number	:	1346769148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY MARIE FOLTZ OTR/L

Provider Business Mailing Address
First Line	:	38 W CHURCH ST
Second Line	:
City	:	FAIRPORT
State	:	NY
Zip	:	14450-2176
Country	:	US
Telephone Number	:	585-421-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	38 W CHURCH ST
Second Line	:
City	:	FAIRPORT
State	:	NY
Zip	:	14450-2176
Country	:	US
Telephone Number	:	585-421-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2017
Last Update Date	:	10/31/2024

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