Provider Demographics
NPI:1699208926
Name:MCFARREN, KIMBERLY S (LMT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:MCFARREN
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 1:771B STATE ROUTE 97
Mailing Address - Street 2:
Mailing Address - City:PERRYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44864
Mailing Address - Country:US
Mailing Address - Phone:330-317-7518
Mailing Address - Fax:
Practice Address - Street 1:771B STATE ROUTE 97
Practice Address - Street 2:
Practice Address - City:PERRYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44864
Practice Address - Country:US
Practice Address - Phone:330-317-7518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.011249225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist