MEDICARE: KIMBERLY LOVE INTINO OT

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	022653	NY

General Provider Information

NPI Number	:	1942796487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY LOVE INTINO OT

Provider Business Mailing Address
First Line	:	4820 W TAFT RD STE 202
Second Line	:
City	:	LIVERPOOL
State	:	NY
Zip	:	13088-2806
Country	:	US
Telephone Number	:	315-552-0406
Fax Number	:	315-634-6230

Provider Business Practice Location Address
First Line	:	4820 W TAFT RD STE 202
Second Line	:
City	:	LIVERPOOL
State	:	NY
Zip	:	13088-2806
Country	:	US
Telephone Number	:	315-552-0406
Fax Number	:	315-634-6230

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

Provider Enumeration Date	:	07/09/2018
Last Update Date	:	08/12/2024

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Directions to “ KIMBERLY LOVE INTINO OT” Practice Location

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