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NPI Code Detail

MEDICARE: KIMBERLY NICOLE TANISH OTR/L

MEDICARE:   KIMBERLY NICOLE TANISH  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
1225X00000XOccupational TherapistOC011101PA

General Provider Information

NPI Number : 1508181934
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY NICOLE TANISH OTR/L
Provider Business Mailing Address
First Line : 455A BUTTONWOOD LN
Second Line :
City : YORK
State : PA
Zip : 17406-9060
Country : US
Telephone Number : 814-659-8809
Fax Number :
Provider Business Practice Location Address
First Line : 200 PAULINE DR
Second Line :
City : YORK
State : PA
Zip : 17402-4625
Country : US
Telephone Number : 717-741-0824
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2010
Last Update Date : 03/29/2010

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Directions to “ KIMBERLY NICOLE TANISH OTR/L” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.