Provider Demographics
NPI:1346782232
Name:ALLSUP, KIMBERLY
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:ALLSUP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 GAVIAT RD
Mailing Address - Street 2:
Mailing Address - City:NORTHWOOD
Mailing Address - State:NH
Mailing Address - Zip Code:03261-3349
Mailing Address - Country:US
Mailing Address - Phone:603-942-6545
Mailing Address - Fax:
Practice Address - Street 1:325 DANIEL WEBSTER HWY
Practice Address - Street 2:
Practice Address - City:BOSCAWEN
Practice Address - State:NH
Practice Address - Zip Code:03303-2410
Practice Address - Country:US
Practice Address - Phone:603-796-2165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0720224Z00000X
MA3409224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant