Provider Demographics
NPI:1548500051
Name:BITTNER, KIMBERLY MICHELLE
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:MICHELLE
Last Name:BITTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENWOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-3512
Mailing Address - Country:US
Mailing Address - Phone:856-217-8697
Mailing Address - Fax:
Practice Address - Street 1:412 6TH AVE
Practice Address - Street 2:
Practice Address - City:LINDENWOLD
Practice Address - State:NJ
Practice Address - Zip Code:08021-3512
Practice Address - Country:US
Practice Address - Phone:856-217-8697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ00320630222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist