Provider Demographics
NPI:1033353677
Name:PURDY, KIM MARIE
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:MARIE
Last Name:PURDY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KIM
Other - Middle Name:MARIE
Other - Last Name:PURDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ABT AND HOMEOPATHY
Mailing Address - Street 1:29 COTTAGE AVE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5213
Mailing Address - Country:US
Mailing Address - Phone:617-479-1030
Mailing Address - Fax:
Practice Address - Street 1:29 COTTAGE AVE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5213
Practice Address - Country:US
Practice Address - Phone:617-479-1030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No175L00000XOther Service ProvidersHomeopath