Provider Demographics
NPI:1275939175
Name:KIMBALL, CAREY ANNE (MT)
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:ANNE
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 COTTAGE STREET, SUITE 5
Mailing Address - Street 2:PROFESSIONAL MASSAGE AND SKIN CARE
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641
Mailing Address - Country:US
Mailing Address - Phone:802-522-8976
Mailing Address - Fax:
Practice Address - Street 1:15 COTTAGE STREET, SUITE 5
Practice Address - Street 2:PROFESSIONAL MASSAGE AND SKIN CARE
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641
Practice Address - Country:US
Practice Address - Phone:802-522-8976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
327353-00225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty