Basic Information
| Provider Information | |||||||||
| NPI: | 1700805173 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZIMMERMAN | ||||||||
| FirstName: | KIM | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 NORTHAMPTON STREET | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021184010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174339601 | ||||||||
| FaxNumber: | 6174456538 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 NORTHAMPTON STREET | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021184010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174339601 | ||||||||
| FaxNumber: | 6174456538 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 10/22/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 447 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.