Provider Demographics
NPI:1942796487
Name:INTINO, KIMBERLY LOVE (OT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LOVE
Last Name:INTINO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:LOVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4820 W TAFT RD STE 202
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-2806
Mailing Address - Country:US
Mailing Address - Phone:315-552-0406
Mailing Address - Fax:315-634-6230
Practice Address - Street 1:4820 W TAFT RD STE 202
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-2806
Practice Address - Country:US
Practice Address - Phone:315-552-0406
Practice Address - Fax:315-634-6230
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022653225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist