MEDICARE: KIMBERLY M STEVENS 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	225X00000X	Occupational Therapist	015931-1	NY

General Provider Information

NPI Number	:	1093044158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY M STEVENS OTR/L

Provider Business Mailing Address
First Line	:	3526 OLD SALT RD
Second Line	:
City	:	MORAVIA
State	:	NY
Zip	:	13118-2211
Country	:	US
Telephone Number	:	315-406-2675
Fax Number	:	315-364-8016

Provider Business Practice Location Address
First Line	:	2384 STATE ROUTE 34B
Second Line	:
City	:	AURORA
State	:	NY
Zip	:	13026-9743
Country	:	US
Telephone Number	:	315-406-2675
Fax Number	:

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

Provider Enumeration Date	:	12/18/2009
Last Update Date	:	08/08/2024

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