Provider Demographics
NPI:1609159318
Name:NOLL, KIMBERLY SUE (LMT)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:SUE
Last Name:NOLL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8066 W SUGAR GROVE RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45318-9712
Mailing Address - Country:US
Mailing Address - Phone:937-609-0845
Mailing Address - Fax:937-473-3974
Practice Address - Street 1:8066 W SUGAR GROVE RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:OH
Practice Address - Zip Code:45318-9712
Practice Address - Country:US
Practice Address - Phone:937-609-0845
Practice Address - Fax:937-473-3974
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH17758225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist