Healthcare Provider Details

I. General information

NPI: 1760740906
Provider Name (Legal Business Name): KIMBERLY S GITTINGER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 DUNCAN AVE
CINCINNATI OH
45208-2822
US

IV. Provider business mailing address

1309 DUNCAN AVE
CINCINNATI OH
45208-2822
US

V. Phone/Fax

Practice location:
  • Phone: 513-470-7292
  • Fax:
Mailing address:
  • Phone: 513-470-7292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT.007482
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: