Healthcare Provider Details

I. General information

NPI: 1437707189
Provider Name (Legal Business Name): KIMBERLY MARY BYRNE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 RIGHTER AVE
DENVILLE NJ
07834-2114
US

IV. Provider business mailing address

49 EAST ST APT 202
ANNANDALE NJ
08801-3141
US

V. Phone/Fax

Practice location:
  • Phone: 201-371-7700
  • Fax:
Mailing address:
  • Phone: 908-328-2243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number46TR00877700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: