Individual
MRS. KIM MORTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1752 E 9TH ST APT C10, BROOKLYN, NY 11223-2316
(646) 806-6772
Mailing address
1752 E 9TH ST APT C10, BROOKLYN, NY 11223-2316
(646) 806-6772
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
XP46345A
—
NY
Enumeration date
06/13/2022
Last updated
06/13/2022
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