Healthcare Provider Details

I. General information

NPI: 1043489073
Provider Name (Legal Business Name): KIMBERLY ANN JORDAN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2008
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2277 GOSHEN TPKE
MIDDLETOWN NY
10941-4032
US

IV. Provider business mailing address

2277 GOSHEN TPKE
MIDDLETOWN NY
10941-4032
US

V. Phone/Fax

Practice location:
  • Phone: 845-692-4391
  • Fax:
Mailing address:
  • Phone: 845-692-4391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number009548
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: