Provider Demographics
NPI:1437696473
Name:JOHNSON, KIMBERLY (LMT, OMT)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMT, OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 243
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04098-0243
Mailing Address - Country:US
Mailing Address - Phone:207-233-2096
Mailing Address - Fax:
Practice Address - Street 1:4 FUNDY RD STE 103
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1764
Practice Address - Country:US
Practice Address - Phone:207-233-2096
Practice Address - Fax:207-808-8000
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-29
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT4594225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist