Provider Demographics
NPI:1639561483
Name:BRUNNOCK, KIMBERLY (OT/R)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BRUNNOCK
Suffix:
Gender:F
Credentials:OT/R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 NEW BRITAIN RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-1395
Mailing Address - Country:US
Mailing Address - Phone:860-827-9364
Mailing Address - Fax:860-505-8973
Practice Address - Street 1:279 NEW BRITAIN RD
Practice Address - Street 2:SUITE 9
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-1395
Practice Address - Country:US
Practice Address - Phone:860-827-9364
Practice Address - Fax:860-505-8120
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2632225X00000X, 225XN1300X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation