Individual
MS. KIMBERLY MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
21000 EDUCATION CT, BROADLANDS, VA 20148-5526
(571) 252-1000
Mailing address
21000 EDUCATION CT, BROADLANDS, VA 20148-5526
(571) 252-1000
(434) 979-8536
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
0119001556
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1906722
FIRST HEALTH
VA
01
—
225539
SOUTHERN HEALTH
VA
Enumeration date
03/21/2007
Last updated
04/02/2018
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