Provider Demographics
NPI:1043576879
Name:ZANIEWSKI, KIMBERLY ANN (OT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:ZANIEWSKI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 POST OFFICE SQ
Mailing Address - Street 2:STE 3600
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-2106
Mailing Address - Country:US
Mailing Address - Phone:866-590-0011
Mailing Address - Fax:888-445-3937
Practice Address - Street 1:1 POST OFFICE SQ
Practice Address - Street 2:STE 3600
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-2106
Practice Address - Country:US
Practice Address - Phone:866-590-0011
Practice Address - Fax:888-445-3937
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003905225XL0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow Vision