Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 9755 | MA |
NPI | 1003109067 |
---|---|
Provider Name | Miss Alexandra Storb Kimball |
First Address | Sherborn, MA 01770-1064 |
Second Address | Plymouth, MA 02360-2183 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2011 |
Last Update Date | 24/05/2011 |