1588700934 NPI number — MRS. KIMBERLY LYNN DOTY M.S. OTR

Table of content: MRS. KIMBERLY LYNN DOTY M.S. OTR (NPI 1588700934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588700934 NPI number — MRS. KIMBERLY LYNN DOTY M.S. OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOTY
Provider First Name:
KIMBERLY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S. OTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588700934
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 SPRING CREEK DR
Provider Second Line Business Mailing Address:
APARTMENT 1
Provider Business Mailing Address City Name:
HORSEHEADS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14845-1665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-738-3112
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ST. JOSEPH'S HOSPITAL
Provider Second Line Business Practice Location Address:
555 EAST MARKET STREET
Provider Business Practice Location Address City Name:
ELMIRA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-733-6541
Provider Business Practice Location Address Fax Number:
607-737-1532
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  011732 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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