Provider Demographics
NPI:1598181570
Name:MCCLEARY, KIMBERLY
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MCCLEARY
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 1:113 OAKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17554-1867
Mailing Address - Country:US
Mailing Address - Phone:717-285-0001
Mailing Address - Fax:
Practice Address - Street 1:113 OAKRIDGE DR
Practice Address - Street 2:
Practice Address - City:MOUNTVILLE
Practice Address - State:PA
Practice Address - Zip Code:17554-1867
Practice Address - Country:US
Practice Address - Phone:717-285-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG006221225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist