Healthcare Provider Details

I. General information

NPI: 1982915062
Provider Name (Legal Business Name): KIM DOLAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 52ND ST
BROOKLYN NY
11219-3434
US

IV. Provider business mailing address

571 PROSPECT AVE
BROOKLYN NY
11215-6020
US

V. Phone/Fax

Practice location:
  • Phone: 718-437-2240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number002872-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: