Provider Demographics
NPI:1730342908
Name:SANDS, KIM WELLS (OTD)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:WELLS
Last Name:SANDS
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16107 PRESIDIO WAY
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1911
Mailing Address - Country:US
Mailing Address - Phone:301-218-5268
Mailing Address - Fax:
Practice Address - Street 1:16107 PRESIDIO WAY
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1911
Practice Address - Country:US
Practice Address - Phone:301-218-5268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDOT919225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist